Lineman, Dead at 36, Exposes Brain Injuries By ALAN SCHWARZPublished: June 15, 2007WEST SENECA, N.Y., June 13 — Mary Strzelczyk spoke to the computer screen as clearly as it was speaking to her. “Oh, Justin,” she said through sobs, “I’m so sorry.”

Justin Strzelczyk was killed during a high-speed police chase on Sept. 30, 2004, when his pickup collided with a tractor-trailer and exploded.

The images on the screen were of magnified brain tissue from her son, the former Pittsburgh Steelers offensive lineman Justin Strzelczyk, who was killed in a fiery automobile crash three years ago at age 36. Four red splotches specked an otherwise tranquil sea — early signs of brain damage that experts said was most likely caused by the persistent head trauma of life in football’s trenches.

Strzelczyk (pronounced STRELL-zick) is the fourth former National Football League player to have been found post-mortem to have had a condition similar to that generally found only in boxers with dementia or people in their 80s. The diagnosis was made by Dr. Bennet Omalu, a neuropathologist at the University of Pittsburgh Medical Center. In the past five years, he has found similar damage in the brains of the former N.F.L. players Mike Webster, Terry Long and Andre Waters. The finding will add to the growing evidence that longtime football players, particularly linemen, might endure hidden brain trauma that is only now becoming recognized.

“This is irreversible brain damage,” Omalu said. “It’s most likely caused by concussions sustained on the football field.”

Dr. Ronald Hamilton of the University of Pittsburgh and Dr. Kenneth Fallon of West Virginia University confirmed Omalu’s findings of chronic traumatic encephalopathy, a condition evidenced by neurofibrillary tangles in the brain’s cortex, which can cause memory loss, depression and eventually Alzheimer’s disease-like dementia. “This is extremely abnormal in a 36-year-old,” Hamilton said. “If I didn’t know anything about this case and I looked at the slides, I would have asked, ‘Was this patient a boxer?’ ”

The discovery of a fourth player with chronic traumatic encephalopathy will most likely be discussed when N.F.L. officials and medical personnel meet in Chicago on Tuesday for an unprecedented conference regarding concussion management. The league and its players association have consistently played down findings on individual players like Strzelczyk as anecdotal, and widespread survey research of retired players with depression and early Alzheimer’s disease as of insufficient scientific rigor.

The N.F.L. spokesman Greg Aiello said that the league had no comment on the Strzelczyk findings. Gene Upshaw, executive director of the N.F.L. Players Association, did not respond to telephone messages seeking comment.

Strzelczyk, 6 feet 6 inches and 300 pounds, was a monstrous presence on the Steelers’ offensive line from 1990-98. He was known for his friendly, banjo-playing spirit and gluttony for combat. He spiraled downward after retirement, however, enduring a divorce and dabbling with steroid-like substances, and soon before his death complained of depression and hearing voices from what he called “the evil ones.” He was experiencing an apparent breakdown the morning of Sept. 30, 2004, when, during a 40-mile high-speed police chase in central New York, his pickup truck collided with a tractor-trailer and exploded, killing him instantly.

Largely forgotten, Strzelczyk’s case was recalled earlier this year by Dr. Julian Bailes, the chairman of the department of neurosurgery at West Virginia University and the Steelers’ team neurosurgeon during Strzelczyk’s career. (Bailes is also the medical director of the University of North Carolina’s Center for the Study of Retired Athletes and has co-authored several prominent papers identifying links between concussions and later-life emotional and cognitive problems.) Bailes suggested to Omalu that Strzelczyk’s brain tissue might be preserved at the local coroner’s office, a hunch that proved correct.

Mary Strzelczyk granted permission to Omalu and his unlikely colleague, the former professional wrestler Christopher Nowinski, to examine her son’s brain for signs of chronic traumatic encephalopathy. Nowinski, a former Harvard football player who retired from wrestling because of repeated concussions in both sports, has become a prominent figure in the field after spearheading the discovery earlier this year of C.T.E. inside the brain of Andre Waters, the former Philadelphia Eagles defensive back who committed suicide last November at age 44.

Tests for C.T.E., which cannot be performed on a living person other than through an intrusive tissue biopsy, confirmed the condition in Strzelczyk two weeks ago. Omalu and Nowinski visited Mary Strzelczyk’s home near Buffalo on Wednesday to discuss the family’s psychological history as well as any experiences Justin might have had with head trauma in and out of sports. Mary Strzelczyk did not recall her son’s having any concussions in high school, college or the N.F.L., and published Steelers injury reports indicated none as well.

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Omalu remained confident that the damage was caused by concussions Strzelczyk might not have reported because — like many players of that era — he did not know what a concussion was or did not want to appear weak. Omalu also said that it could have developed from what he called “subconcussive impacts,” more routine blows to the head that linemen repeatedly endure.

“Could there be another cause? Not to my knowledge,” said Bailes, adding that Strzelczyk’s car crash could not have caused the C.T.E. tangles. Bailes also said that bipolar disorder, signs of which Strzelczyk appeared to be increasingly exhibiting in the months before his death, would not be caused, but perhaps could be exacerbated, by the encephalopathy.

Omalu and Bailes said Strzelczyk’s diagnosis is particularly notable because the condition manifested itself when he was in his mid-30s. The other players were 44 to 50 — several decades younger than what would be considered normal for their conditions — when they died: Long and Waters by suicide and Webster of a heart attack amid significant psychological problems.

Two months ago, Omalu examined the brain tissue of one other deceased player, the former Denver Broncos running back Damien Nash, who died in February at 24 after collapsing following a charity basketball game. (A Broncos spokesman said that the cause of death has yet to be identified.) Omalu said he was not surprised that Nash showed no evidence of C.T.E. because the condition could almost certainly not develop in someone that young. “This is a progressive disease,” he said.

Omalu and Nowinski said they were investigating several other cases of N.F.L. players who have recently died. They said some requests to examine players’ brain tissue have been either denied by families or made impossible because samples were destroyed.

Bailes, Nowinski and Omalu said that they were forming an organization, the Sports Legacy Institute, to help formalize the process of approaching families and conducting research. Nowinski said the nonprofit program, which will be housed at a university to be determined and will examine the overall safety of sports, would have an immediate emphasis on exploring brain trauma through cases like Strzelczyk’s. Published research has suggested that genetics can play a role in the effects of concussion on different people.

“We want to get a idea of risks of concussions and how widespread chronic traumatic encephalopathy is in former football players,” Nowinski said. “We are confident there are more cases out there in more sports.”

Mary Strzelczyk said she agreed to Omalu’s and Nowinski’s requests because she wanted to better understand the conditions under which her son died. Looking at the C.T.E. tangles on a computer screen on Wednesday, she said they would be “a piece of the puzzle” she is eager to complete for herself and perhaps others.

“I’m interested for me and for other mothers,” she said. “If some good can come of this, that’s it. Maybe some young football player out there will see this and be saved the trouble.”

I took a brain science class about a year ago. The professor said that any concussive injury to the head causes irrepairable damage to the brain. Also, there was a visiting brain surgeon whose speciality is Parkinson's disease. He said that Parkinson's and Alzhiemer's are both common in aging contact athletes. He said that Muhammid Ali's Parkinson's was most likely caused by multiple concussions over a life of getting hit in the head.The fact that Parkinson's disease is not common among African Americans makes it a more reasonable assumption.

When I was younger and had dreams of becoming a boxer, an older guy who knew I wanted to be a boxer, took me to a charity dinner for an old Italian boxer. There were some famous retired champs there. I was about 16-17 years old. I remember thinking, "these guys are not the sharpest tacks in the bunch." It had a big impact on my career choice.

I would bet that as more research comes in, the quote, "higher consciousness through harder contact," might not withstand the test of time; although, I personally believe that non compliant sparring is necessary to understand movement and spatial relations in martal arts. I am not sure you can reach the higher levels of any martial arts without laying your brain on the line. I guess, the question is..... can a martial artist achieve higher consciousness without contact?

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Forewarned, forearmed; to be prepared is half the victory. Miguel de Cervantes

I took a brain science class about a year ago. The professor said that any concussive injury to the head causes irrepairable damage to the brain. Also, there was a visiting brain surgeon whose speciality is Parkinson's disease. He said that Parkinson's and Alzhiemer's are both common in aging contact athletes. He said that Muhammid Ali's Parkinson's was most likely caused by multiple concussions over a life of getting hit in the head.The fact that Parkinson's disease is not common among African Americans makes it a more reasonable assumption.

When I was younger and had dreams of becoming a boxer, an older guy who knew I wanted to be a boxer, took me to a charity dinner for an old Italian boxer. There were some famous retired champs there. I was about 16-17 years old. I remember thinking, "these guys are not the sharpest tacks in the bunch." It had a big impact on my career choice.

I would bet that as more research comes in, the quote, "higher consciousness through harder contact," might not withstand the test of time; although, I personally believe that non compliant sparring is necessary to understand movement and spatial relations in martal arts. I am not sure you can reach the higher levels of any martial arts without laying your brain on the line. I guess, the question is..... can a martial artist achieve higher consciousness without contact?

I think one may reach the higher levels of martial arts without extreme contact with propper guidance. I also believe it would take substantially less time to reach the same skill levels when adding harder contact to your training. It is a personnel choice one must make. One thing is for sure, there is no easy road and one way or the other the price must be payed. To me that is a big part of the beauty and honesty of martial art.

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« Last Edit: June 22, 2007, 08:37:14 PM by Tom Stillman »

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Live a good, honorable life. Then when you get older and think back, you'll be able to enjoy it a second time. dalai lama

speaking of brain injuries... there was a brief episode on Good Morining America? that chronic T.B.I. from combat sports may be contributing to an increase in alzheimers and parkinsons among pro athletes. it was said that this may be a cause of Ali's parkinsons, stating that parkisons is relatively lo throughout the male african-american community.

on top of that, i've been following Hypebaric Oxygen Therapy is now being widely used to treat most sports injuries especially in combat sports athletes. My term paper graduating dive school shows that increased oxygen under pressure will reduce edema, hyper-oxygenates blood and plasma after increased blood loss, and forces circulation to all ischemic tissues. this greatly improves recovery and recovery time. Holyfield used it after his concussions and i'm sure Rahman needed it with that tomato sized hematoma over his left brow. just left the commercial dive community to persue sports therapy with HBOT.

Krait 44 said:I would bet that as more research comes in, the quote, "higher consciousness through harder contact," might not withstand the test of time; although, I personally believe that non compliant sparring is necessary to understand movement and spatial relations in martal arts. I am not sure you can reach the higher levels of any martial arts without laying your brain on the line. I guess, the question is..... can a martial artist achieve higher consciousness without contact?

........high level sparrring/fighting with bladed weapons. Ideally the only contact is my blade, your body....and exit! (this came up on the blade sparring thread).

Otherwise i totally agree that what you practice has to work on someone that does not want it to, or else it means little. However, If you are willing to risk permanent brain injury or some form of early dementia to reach your goals, you better have been paid very highly for the priviledge or have no other options.We all live in a spectrum. There will always be people with worse skill levels and always people who are better. Even "the best fighter" in the world has off days, so what are we aiming for? If the answer is "higher consciousness" , i personally would like it to continue growing into old age.

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It will seem difficult at first, but everything is difficult at first. Miyamoto Musashi.

The interesting aspect of what I am posting is about who the person who got his a$$ most kicked was. Who would you put your money on in a street fight? A stone cold thug who has been fighting for real all his life, or a martial arts enthusiast?:

For someone being sued for $20 million, Allen Iverson didn't spend very much time in court: an hour or so, just long enough to tell the jury that he didn't see his security detail get into a brawl with two men at a downtown Washington club.

Yesterday, after six days of trial and about 13 hours of deliberations, a jury said the NBA star must be held accountable, ordering that Iverson and his bodyguard pay $260,000 in damages to one of the Maryland men roughed up in the fracas.

Iverson was not at the federal courthouse in Washington when the verdict was delivered, and neither was the bodyguard, Jason Kane. But jurors did give them one break: They decided against making the Denver Nuggets guard and his beefy 6-foot-3 security escort pay a fortune in punitive damages.

The $260,000 was awarded to Marlin Godfrey, 37, who said he suffered an injured rotator cuff, temporary loss of hearing and broken blood vessels in his head in the brawl early on July 20, 2005. The defendants were ordered to pay $10,000 for Godfrey's medical expenses and the rest to compensate him for pain and suffering.

The jury rejected claims by a second plaintiff, David A. Kittrell, also 37, who said he suffered bruises and emotional distress. Godfrey and Kittrell testified that they were beaten by Kane and another man, Terrence Williams, because they didn't leave the VIP section at Eyebar when Iverson's entourage arrived and told them to clear out.

"For me, it was never about the money," Godfrey, a Lanham-based martial arts school owner and instructor, said after the verdict. "It was holding them accountable for their actions."

The suit accused Iverson, 32, of failing to supervise his security team. The jury found that Williams, who described himself as an Iverson acquaintance, was not employed by the basketball star. But the panel held Iverson and Kane responsible for the trouble.

Stephanie D. Moran, one of Godfrey's attorneys, said the verdict "sent a clear message that Allen Iverson was accountable and he could not turn his head or say he didn't know."

The fighting occurred during Iverson's annual celebrity charity softball weekend. Iverson, a former Georgetown Hoya, will be in Washington this weekend for the event, which opens with a party Friday at the Love nightclub in Northeast.

Police investigated the fight at Eyebar, in the 1700 block of I Street NW, but no charges were filed in the case.

Attorneys for Iverson and Kane said they will appeal.

"We are tremendously displeased in the verdict," said Alan C. Milstein, who with co-counsel Billy Martin represented Iverson and Kane.

During the trial, Milstein and Martin argued that the lawsuit was about nothing but money, and in his testimony, Iverson said the plaintiffs "want to become rich overnight." Iverson testified that he was at Eyebar for about 20 minutes and did not see the five-minute fight erupt.

Kane, 35, testified that he shoved one of the club's security officers when he arrived at the nightspot but denied hitting Godfrey. Attorneys for Godfrey and Kittrell alleged that Kane struck Godfrey with wine glasses.The jury returned its verdict in two stages. After awarding Godfrey the $260,000, the panel heard arguments about punitive damages. The plaintiffs' attorneys told the jury that Iverson's annual income was listed at $23 million. "What happened here has to be rectified," said Gregory Lattimer, an attorney for Godfrey.

The defense urged that no more money be awarded, saying that Iverson showed no malice and that Kane's security career was almost certainly in peril.

In interviews after the verdict, some jurors said the decision came down to the credibility of the witnesses.

"This whole case was based on witnesses, listening to Kane's friends versus Godfrey's friends," said jury foreman Dave Peterson. "Whose friends are you going to believe?"

Juror Althea Hill said the panel believed that Iverson was liable for the fight because he hired Kane. "When you hire someone to do work for you, you should check out all aspects and know everything there is to know about your employee," she said.

The jury said Williams, who witnesses agreed was at the center of the fight, was only attending a party at Eyebar and was not working for Iverson, as the plaintiffs' attorneys had contended.

Iverson could be returning to the courthouse soon for another court fight. Pending is a lawsuit involving a June 2004 incident at Zanzibar on the Waterfront, another D.C. nightclub. In that case, Gregory Broady, an information technology specialist from Maryland, is suing Iverson and Zanzibar, alleging that someone in Iverson's security team struck him in the head. Broady is seeking $750,000 in damages.

Milstein said that Iverson "doesn't even remember being there" the night of the Zanzibar fight and that Zanzibar's security was responsible for Broady's injuries. Zanzibar attorney Andrew B. Greenspan declined to comment on the case. A pretrial hearing is set for Friday.Staff writer Jenna Johnson contributed to this report.

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"This is a war, and we are soldiers. Death can come for us at any time, in any place." ~ Morpheus

Who would you bet on living a longer healthier life? I would bet that most TMAs live longer and have a higher quality of life than Stone cold thugs. Trying to determine who is a better fighter gets in that sticky area between Self defense and what Marc Denny calls, "Young male ritual hierarchial contests." (YMRHC)

I believe that quality of life issues become an often overlooked ingredient when we try to decide fighting methods. Along those lines we have to ask, who lives longer healthier lifes? A Stone cold thiug or a TMA? Would anyone ever say, including Stone cold thugs, that people who learn to fight in the underbelly of America made a good lifestlye choice?

Maija,

I like what you said referring to your sword training and not getting hit thus achieving higher consciouness. Your skills attest to that. The harder contact, I was writing on is in reference to full contact sports. The nature of sword can not be a full contact sport, at least not in America.

« Last Edit: July 13, 2007, 01:53:31 PM by krait44 »

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Forewarned, forearmed; to be prepared is half the victory. Miguel de Cervantes

Todd Heisler/The New York TimesKelby Jasmon, left, like many high school teammates, said he would not tell his coach if he thought he had a concussion.

By ALAN SCHWARZPublished: September 15, 2007To Kelby Jasmon, there was only one answer. The question: If he received yet another concussion this football season, while playing offensive and defensive line for his high school in Springfield, Ill., would he tell a coach or trainer?

“It’s not dangerous to play with a concussion,” said Kelby Jasmon, a senior two-way player for his high school in Springfield, Ill., who has had three concussions. “You’ve got to sacrifice for the sake of the team. The only way I come out is on a stretcher.”

Jasmon, with his battering-ram, freshly buzz-cut head and eyes that danced with impending glory, immediately answered: “No chance. It’s not dangerous to play with a concussion. You’ve got to sacrifice for the sake of the team. The only way I come out is on a stretcher.”

Jasmon, a senior with three concussions on his résumé, looked at two teammates for support and unity. They said the same thing with the same certainty: They did not quite know what a concussion was, and would never tell their coaches if they believed they had sustained one.

Matt Selvaggio, who plays with Jasmon on both lines, said: “Our coaches would take us out in a second. So why would we tell them?”

Many of the 1.2 million teenagers who play high school football are chanting similar war whoops as they strap on their helmets. They either do not know what a concussion is or they simply do not care. Their code of silence, bred by football’s gladiator culture, allows them to play on and sometimes be hurt much worse — sometimes fatally.

The National Football League has recently faced questions about its handling of concussions after four former players were found to have significant brain damage as early as their mid-30s. But teenagers are more susceptible to immediate harm from such injuries because, studies show, their brain tissue is less developed than adults’ and more easily damaged. High school players also typically receive less capable medical care, or none at all.

At least 50 high school or younger football players in more than 20 states since 1997 have been killed or have sustained serious head injuries on the field, according to research by The New York Times.

Experts say many of these accidents could have been prevented by simple awareness of and respect for their gravity.

Poor management of high school players’ concussions “isn’t just a football issue,” said Robert Sallis, president of the American College of Sports Medicine. “It’s a matter of public health.”

Interviews with players indicate that even those aware of the dangers of concussions ignore them. Coaches, trainers and parents can detect a gimpy knee or a separated shoulder, and act. But a concussion is often the player’s secret. It is the one injury no one sees — until a case like Will Benson’s, which no one forgets.

Benson carried himself with a verticality that captivated teachers, classmates and coaches. A handsome, straight-A student headed for the Ivy League, he was the star quarterback for St. Stephen’s Episcopal School in Austin, Tex.

“He loved the idea of playing for his teammates and his brothers on that battlefield of the gridiron,” recalled his good friend and classmate Kashif Sweet, now a senior at Columbia. “He was a naturally tough kid with a high threshold for pain. He liked to endure things, to conquer things, and have people follow him.”

On a play during St. Stephen’s first game of 2002, as a pile of bodies grew too dense to see through, a crack was heard throughout the stadium: the sound of helmet meeting helmet, two shells of polycarbonate alloy crashing together.

Watching from the stands, Judy Ryser, Benson’s mother, heard the sound — everyone did — and turned to a friend next to her.

“Oh, my goodness,” she said. “I hope that wasn’t Will.”

In the stifling heat of July in Alabama, hundreds of high school players from across the United States gathered at Hoover High School outside Birmingham, preparing to compete in a preseason tournament. They ambled about the field in baggy polyester shorts, helmets dangling from their fingers. Give them each five years and 50 pounds, and it could be an N.F.L. rookie camp.

Some sat on the grandstand’s metal benches, waiting for their games to begin. They were asked about concussions.

Garrick Jones, a senior quarterback at Whitehaven High School in Memphis, said he sustained one last year: He was briefly knocked unconscious when a linebacker picked him up and threw him to the ground on his head. No flag was thrown. He said he wobbled to the huddle, took the next snap and dropped back to pass before his vision blurred completely.

“I couldn’t come out — my team needed me,” Jones said. “You have to keep playing — until you can’t.”

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Some players airily guessed at describing a concussion: “You feel dizzy and stuff”; “when you’re cross-eyed”; “when you feel real sleepy”; “it’s like when you turn into someone else.” Only a few of more than 50 players interviewed at the tournament came close to defining the injury: a blow to the head that causes the brain to crash into the skull. Concussion — the word derives from the Latin concutere, meaning shake violently — is typically followed by dizziness, headache, nausea, lethargy, impaired vision or other disruptions in brain function.

Will Benson (7) returned to the field two weeks after a hard helmet-to-helmet hit, but left the game saying he felt weird. He died five days later.

Ben Mangan, 20, says he still feels the effects of a concussion in 2002. “I was a B student in math before, but now I sit there and I’m like, Why can’t I get this?”

Studies show that concussions are drastically underreported in high school football in part because many youngsters — even adults — still mistakenly think the injury requires the player to have been knocked unconscious. Athletic trainers report about 5 percent of high school players as having had a concussion each season, studies show, but formal widespread surveys of players strongly suggest the number is much higher.

Anonymous questionnaires that ask specifically about concussions have reported rates among high school football players at about 15 percent each season; when the word concussion is omitted and a description of symptoms is provided instead, close to 50 percent of players say they had one, with 35 percent reporting two or more. Although concussions remain one of the more imprecise diagnoses in sports medicine — magnetic resonance imaging exams and CAT scans cannot detect them — the players’ testimony has been taken by experts to indicate that a vast majority of concussions are not treated.

Asked to define a concussion, Josh Bailey, a senior safety at Patterson High in Louisiana, could not. After being told, he said he definitely had one last year, when his head slammed against another player’s knee. He said no one noticed, and he never considered leaving the game.

“Football, it’s all about contact — you kind of have to suck it up,” Bailey said. “Because you’re going to feel pain. That’s what the game is about. If you don’t put yourself through that, you don’t really love the game.”

The crack on the St. Stephen’s field five years ago was indeed the sound of Will Benson’s helmet slamming into another. He played the rest of the game, which his team lost. Admitting to headaches several days later, Benson sat out the next game — and St. Stephen’s lost again.

“He felt a lot of responsibility,” recalled Jay Lamy, a volunteer coach that season. “He didn’t want to let his teammates down. He knew the impact that he had.”

That influence was felt the next Friday night. Filling his No. 7 uniform as only a star quarterback can, Benson ran for a touchdown in the first quarter.

But later in the half, with seemingly no provocation, he took off his helmet and walked off the field. Benson told his coach he felt weird and had “big blobs” in his vision. He sat on the bench and put a towel over his head. Then a golf cart took him to the trainer’s room.

A few minutes later, Benson was screaming in a way that no one present will ever forget.

“Mom!” he shrieked before he lost consciousness.

“Mom!”

“Mom!”

Doctors call it second-impact syndrome. Almost solely among teenagers, sustaining another blow to the head — even a seemingly benign one — before a first has healed can set off a devastating chain of metabolic events: Cerebral blood flow increases, arteries swell past capacity, and pressure builds inside the brain, often leading to coma and death. Helmets can do only so much to keep youngsters’ brains from sloshing inside their skulls, like the yolk inside an egg.

A recent study in The American Journal of Sports Medicine led by Barry P. Boden of the Orthopaedic Center in Rockville, Md., found that catastrophic football head injuries were three times as prevalent among high school players as college players — and that “an unacceptably high percentage of high school players were playing with residual symptoms from a prior head injury.”

For many victims, staying alive is only the first challenge. Kort Breckenridge of Tetonia, Idaho, has trouble holding down a job because of short-term memory problems stemming from a football brain injury two years ago. Brady Beran of Lincoln, Neb., emerged from a coma reading at a kindergarten level; he remains in physical therapy with hopes of running again.

Second-impact syndrome is relatively rare, however. Experts said that for every such case there can be hundreds of victims of postconcussion syndrome, leaving youngsters depressed, irritable and unable to concentrate, and they sometimes miss school for weeks or perform poorly on tests. Ben Mangan of Lewisburg, Ohio, still has mood swings and cognitive problems deriving from at least one major concussion in 2002.

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It definitely has held me back in progressing through school,” said Mangan, now 20 and attending a small Ohio college. “I was a B student in math before, but now I sit there and I’m like, Why can’t I get this? I’ll do the same problem five times and keep getting different answers. It’s really frustrating.”

With no limp or wince to advertise most concussions, coaches and sideline medical staff must be keenly aware of their signs; waiting for gross disorientation or nausea invites disaster.

Diagnostic methods vary in science and scope, but most involve asking questions to gauge a player’s awareness, testing short-term memory by repeating strings of words and numbers backward and forward, and administering short pencil-and-paper tests. Players are encouraged to be re-examined after physical exertion to see if headache or cognitive problems return.

Many school districts require an ambulance and paramedics to be on-site in case of emergencies, but a sideline physician is often a luxury. Only 42 percent of high schools in the United States have access to a certified athletic trainer, according to the National Athletic Trainers’ Association.

“Budgets are tight,” said Bob Colgate, the assistant director of the National Federation of State High School Associations. “You hate to say that, but it’s a reality.”

Howells High School is among the 77 percent of Nebraska schools without an athletic trainer. The football coach, Mike Spiers, said that he cannot monitor the health of every player, many of whom he speaks with only a few times a game.

“I have a tremendous fear of all injuries that could permanently damage a kid,” Spiers said. “It’s something that may convince me not to do this anymore.”

At midweek practices, which often feature even more banging and tackling than games, volunteer coaches with little training typically evaluate injuries while the head coach calls plays.

Sallis, of the American College of Sports Medicine, joined many experts in saying he was not trying to discourage the playing of football, only the widespread acceptance of playing it unsafely.

“It’s crazy,” he said. “High schools hire a zillion coaches before they wonder about hiring a trainer. If you hire a head football coach, that next hire should be an athletic trainer.”

As Will Benson wailed, vomited, had a seizure and lost consciousness, the ambulance dispatched for him could not find the entrance to the St. Stephen’s campus. According to records released by the local emergency medical services unit, it spent 13 minutes trying to find the trainer’s room.

A helicopter whisked Benson to a hospital as the game continued. Coaches were confused: He had not been involved in any notable hits or tackles in the game.

Bleeding in his brain, Benson slipped into a coma that night and never regained consciousness. A neurosurgeon operated to relieve pressure inside the skull but could not revive him. Five days later, Benson was declared brain dead. He was kept alive overnight so his organs could be harvested for donation.

There is no shortage of unenlightened coaches. Scott Robertson, a volunteer team physician for Nipomo High in Southern California, said he had seen coaches at other schools “berate and ostracize” players who complained of concussion symptoms. Jerry Bornstein, another team physician for several Los Angeles-area schools, said a coach once yelled at him for refusing to let a concussed player return to a game. His response: “I’ll be happy to, Coach, as long as you accept the responsibility for this kid waking up dead tomorrow morning.”

Ellen Marmer, the team physician for Rockville High School in Vernon, Conn., said that after she determined an offensive player from the opposing team was unfit to play after a concussion, his coach had him switch uniforms to try to play defense.

Parents lose perspective as well. Garrick Jones, a quarterback from Memphis, said that the week after his concussion, his father pleaded with the coach to let him play. (The coach won.) Vito Perriello, the team doctor for St. Anne’s-Belfield School in Charlottesville, Va., said, “I have had parents tear up the form that I’ve filled out strongly recommending their child not play, and shop a doc to get their kid O.K.’d.”

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Yet many experts say that as poorly as adults can behave, it is the football bravado they instill in children, the thirst for competition and the blind eye to pain, that keeps players in the game. More than a dozen high school players at the Alabama tournament said they had hidden concussions from their coaches and medical personnel to stay on the field.

“If the coach knew about it, he’d take us out,” said Matt Arent, a quarterback in Nashville. “They treat us like we’re their own kids. It comes down to the player not telling the coach that something’s wrong.”

Players will hide from trainers and try to sneak back into huddles. They will rehearse answers to impress the trainer, so they won’t forget to use magic phrases like “I don’t have any headache at all” when asked.

One maneuver involves the preseason memory and cognitive tests many schools administer as a baseline for comparison should a player sustain a concussion. Several doctors and trainers said they have heard players boast of purposely doing poorly on the preseason tests so they will be more readily found fit to play.

A paradox has developed in high school football: The more strict the rules, the more likely they are to be evaded by the players they aim to protect. Many doctors support a rule whereby any player sustaining a concussion cannot return to play that day. But Sallis supported a more realistic approach, in which a player may return to the game if doctors are convinced the symptoms have cleared.

If not, Sallis said: “Players are all going to stop telling the team physician that they have any symptoms — they’re going to hide them. Which we know they already do, but I think it’s going to get even worse. It’s putting them at more risk.”

Dick Benson spent five years trying to wring something positive out of his son Will’s death. In June, Will’s Bill, legislation he crusaded for, was signed into law.

It requires every Texas high school coach and official involved in every sport to be trained in basic safety and emergency procedures. Beyond neck injuries and heart attacks, special attention will be afforded to the symptoms of concussion and roots of second-impact syndrome. Benson said: “We’re not teaching people the principles of neurology. This is fundamental, basic stuff.”

The law does not apply to Will’s old high school, however. It originally covered parochial and private schools, but the primary sponsor of the bill, State Senator Leticia Van de Putte, said it became entangled in “a raging school-voucher argument.” The legislation had to be scaled back “over politics,” she said.

Benson said that he hoped that the steps taken in his son’s name would reach other states, but added that the process would be slow at best.

“It usually takes something like Will to get people to take this kind of thing seriously,” he said. “People like learning things the hard way.”

Particularly adolescents. Playing linebacker two years ago, Riley Haynes of Ponte Vedra Beach, Fla., tackled a running back with such force that he found himself on the ground, all but unconscious, not remembering his name. His head throbbed, and he had no idea where he was.

A teammate reminded him. He jumped on top of Haynes and screamed through his face mask: “That’s football, baby! That’s football, baby!”

Haynes gathered himself, stumbled back to his position and took his stance for the next snap

Has anyone ever sustained a head shot that affected them significantly afterwards? I have. I got hit as I was rising from the ground in the back of the head. When I got back to work (technically oriented work) I could not think straight enough to do the math I needed. This lasted for about a month.

Over my lifetime, I have had at least 4 significant concussions, two of which were from martial arts. One was from playing neighborhood football and another was from fall as a kid from a stupid height. I have had my bell mildly rung in practice often enough.

After I got the head shot, I talked seriously to physicians about this. I mean, like most, I tended to shrug off anything mild. One comment I remember was "you have about 3 concussions that you can have in your life. The also told me about Minor Traumatic Brain Injury being more significant than previously thought and they were all concerned with cumulative effects. I think the current trends are more along the lines of getting hit in the head can cause damage and cumulative damage as well. so in effect its common sense. The harder and more often you get hit the more your chances of having some form of trouble over time. I do not believe martial artists should ignore this.

I still believe in the idea of having realistic practice events for a variety of reasons. The middle path is always the hardest. How do you have such realistic practice while not damaging yourself or other in your tribe? I think this is possible to do. But I think this is one of the main reasons that Character Values have to be incorporated into martial arts training. You have to teach right action as well as combat effectiveness. Otherwise your tribe suffers.

About 1.4 million incidents of traumatic brain injury (TBI) are reported in the United States each year,1 of which 75% are classified as "mild."2 Mild TBI (MTBI) results from a number of causes, including falls, interpersonal violence, and motor vehicle collisions.3 Many cases are sports-related; football and wrestling in men and soccer and basketball in women are primary sources.4

Patients who have MTBI may present with varying neurologic findings. Intoxication, preexisting conditions, polypharmacy, and dementia are confounders that are frequently encountered during the evaluation. Management decisions may be challenging in the patient who appears well during the evaluation but who was lethargic, confused, or amnestic at the time of the injury. Patients may also present days or weeks after the event with postconcussive symptoms, such as headache, sleep disturbances, memory and concentration problems, and emotional lability.

This article presents a pragmatic approach to the patient with MTBI, using evidence-based guidelines when available.

CLASSIFICATION OF MTBI

MTBI describes a condition in which there is little or no change from the patient's neurologic baseline after the traumatic event. Although the term "head injury" is often used interchangeably with TBI, this usage is inappropriate. Head injury is defined as clinically evident trauma above the clavicles, including scalp lacerations, periorbital ecchymoses, and forehead abrasions. TBI refers to injury to the brain itself; it may occur without visible head injury. TBI manifests as confusion, focal neurologic abnormalities, altered level of consciousness, and/or subtle changes on neuropsychological testing. It may also appear as an abnormality on cranial CT or MRI scans or during intra-cranial surgeries.

"Concussion" is another term that is used interchangeably with MTBI and defined in various ways in the literature, often in the context of sports injuries.5 Historically, MTBI refers to patients with head injury who have resolving neurologic symptoms and a Glasgow Coma Scale (GCS) score between 13 and 15; concussion refers to patients with head injury who have loss of consciousness (LOC) or amnesia of varying durations. For consistency, we will use the terms "TBI" and "MTBI" unless we refer to a scale or a table using the term "concussion."

There is no evidence-based definition of MTBI; inclusion and exclusion criteria vary by classification scheme. The Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine defines MTBI according to the following criteria6:

- Grade 1: Any alteration in mental state at the time of injury (eg, feeling dazed, disoriented, or confused).

- Grade 2: Any loss of memory of the events immediately before or after the injury, with post-traumatic amnesia of less than 24 hours.

- Grade 3: Any period of LOC of less than 30 minutes followed by a GCS score of 13 to 15.7.

SNELLVILLE, Ga. (AP) -- Police are investigating the death of a man who collapsed after he was head-butted by an armless man in a fight over a woman. Snellville Police Chief Roy Whitehead said the two men, Charles Keith Teer and William Russell Redfern, scuffled Monday afternoon in the driveway of a suburban Atlanta home.

Police say Redfern, who was born with no right arm and only a short stump for his left arm, kicked Teer and Teer hit Redfern during the fight, which was due to long-standing bad blood over a woman who once dated Teer and now dates Redfern.

After the fight, Redfern and the woman got into his truck and drove to the Snellville police station, Whitehead said. He said the couple had called 911 to report the dispute, then told the operator they needed an ambulance after Teer collapsed.

A woman who answered the telephone at Redfern's home, in suburban Tucker, Ga., said he had no comment. She declined to identify herself.

Police are awaiting autopsy results before deciding whether Redfern should be charged.

Known by the nickname "Rusty," Redfern made a name for himself in the late 1980s for pen and ink drawings he does using his foot.

According to the web site for VSA Arts - an affiliate of the John F. Kennedy Center for the Performing Arts that promotes and showcases artists with disabilities - Redfern's drawings take one to six months to complete.

He was one of six Georgians selected to represent the state at the 1989 International Arts Festival in Washington, D.C., and was commissioned by Georgia's then-Secretary of State Max Cleland for a series of illustrations depicting the state capitol.

According to the site, he started Redfern Originals, Inc. in 1987, producing Christmas cards, stationary and limited-edition prints.---------------

SNELLVILLE, Ga. (AP) — An armless artist has turned himself into face a misdemeanor charge in a fight with a man who later died.

Police say William Russell Redfern, who has won recognition fordrawings he does with his feet, head-butted and kicked CharlesKeith Teer during a Sept. 17 fight over a woman. Teer complained ofdizziness and collapsed.

A medical examiner determined last week that Teer likely died ofa heart attack.

Police Chief Roy Whitehead said investigators decided againstfelony charges but felt Redfern should be punished for the fight.

Redfern, who was born with no right arm and a stump below hisleft shoulder, turned himself in Tuesday on a charge of affray. Hewas released Wednesday on $1,213 bond, a jail official said.

The misdemeanor charge is likely the only legal action Redfernwill face, Whitehead said.

“We reviewed (the case), talked with everyone involved and feltlike that was an appropriate charge,” he said.

Known by the nickname “Rusty,” Redfern made a name for himselfin the late 1980s for pen and ink drawings he does using his foot.

New Helmet Design Absorbs Shock in a New Way NY TimesBy ALAN SCHWARZPublished: October 27, 2007

Vin Ferrara, a former Harvard quarterback, was looking for an aspirin in his medicine cabinet when his eyes fixed upon a ribbed plastic bottle used to squirt saline into sinuses. Ferrara squeezed the bottle, then pounded on it — finding that it cushioned soft and hard blows with equal aplomb, almost intelligence. “This is it,” Ferrara declared. Three years later, Ferrara’s squirt bottle has led to a promising new technology to protect football players from concussions.

Football helmets have evolved over more than a century from crude leather bonnets to face-masked, polycarbonate battering rams. But they still often fail to protect brains from the sudden forces that cause concussions. Studies have found that 10 to 50 percent of high school players each season sustain concussions, whose effects can range from persistent memory problems and depression to coma and death.

Contemporary helmet manufacturers have made a point of improving protection against concussions. But experts suspect that Ferrara, who sustained several concussions as a player himself, has developed a radically effective design.

Rather than being lined with rows of traditional foam or urethane, Ferrara’s helmet features 18 black, thermoplastic shock absorbers filled with air that — not unlike his squirt bottle — can accept a wide range of forces and still moderate the sudden jarring of the head that causes concussion. Moreover, laboratory tests have shown that the disks can withstand hundreds of impacts without any notable degradation in performance, a longtime drawback of helmets’ traditional foam.

Dr. Robert Cantu of Brigham and Women’s Hospital in Boston, one of the nation’s leading experts in concussion management, called it “the greatest advance in helmet design in at least 30 years.”

Cantu informally advised Ferrara during the helmet’s development but has no financial relationship with the product.

Dr. Gerry Gioia, a pediatric neuropsychologist who directs the concussion program at the Children’s National Medical Center in Washington, said Ferrara’s helmet could “take helmet protection to a whole new level.”

“I think it’s very real,” Gioia said. “Foams have only had a certain amount of success in absorbing force. Think of what crumple zones in cars meant to reducing injuries. That’s the idea behind this technology — this does what it’s supposed to do better than any other.”

The helmet has not yet been tested by actual players in games. Earlier this month, it passed certification tests conducted by the National Operating Committee on Standards for Athletic Equipment, which certifies helmet models worn by each of the more than 2 million football players in the United States, from pee-wees to professionals.

Ferrara said that his company, Xenith LLC, expected the helmet to be available for the 2008 football season — either produced by Xenith or perhaps by license to an existing manufacturer. The price will be about $350, more than twice the cost of existing headgear. Ferrara, who after graduating from Harvard in 1996 earned medical and business degrees from Columbia, said he expected marketing to focus less on schools, whose budgets are tight, than parents with concern for their child.

“This is more a piece of safety equipment, along the lines of a child car seat, than just a piece of athletic equipment,” Ferrara said.

After raising $10 million in venture capital, Ferrara assembled the engineering team that has turned that squirt bottle into a finished helmet. Three high schools, which Ferrara declined to name because he had promised them anonymity, will begin field-testing it next month. Meanwhile, Ferrara has begun presenting the helmet and its test results to groups of football decision-makers, including the athletic directors of the Big Ten Conference last week.

“It really caught my attention,” said Barry Alvarez, the University of Wisconsin athletic director and former football coach. “Coaches and trainers should really see this thing.”

An N.F.L. spokesman said that the league was aware of Ferrara’s helmet design but had not reviewed it enough to comment.

In part due to liability concerns, the number of helmet manufacturers has decreased over two decades from more than half a dozen to three: Riddell, Schutt and Adams. Eighty-four percent of N.F.L. players choose helmets made by Riddell, which also has an exclusive marketing agreement with the league. Schutt and Adams have far greater market shares on the high school and youth levels, respectively, while exclusive arrangements within leagues or schools are discouraged because head sizes fit better in different brands.

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Football helmets present the technological challenge of protecting against all manner of blows to the head and also doing so thousands of times. (Bicycle helmets, by contrast, are designed to withstand just one major, accidental impact.) Optimally, a helmet’s interior must be forgiving enough to cushion against a routine impact while also sturdy enough to withstand a potentially lethal one — each level of force requires a different response from the material.

.To earn certification, a helmet is impact-tested at dozens of forces and angles, with the energy it still allows to reach the skull measured by what is called severity index. The helmet must always score at 1,200 or below on the severity index because that is the zone that causes fractured skulls, the injury whose prevention historically has been emphasized — quite successfully — in football. Concussions become likely at a severity index of about 300; the certification agency has feared demanding that level of protection because of potential sacrifices it might mean at higher levels.During its certification test this month, the Xenith helmet scored in the 200’s in several key locations and averaged about 340, scores generally lower than those attained by today’s helmet designs. The certification agency’s executive director, Mike Oliver, strongly cautioned against comparing test scores because differences are not as meaningful as they appear.

“Concussion is the big elephant in the room right now when it comes to helmets, and I’m cautiously optimistic at how low these numbers are,” Oliver said. “But you can test as much as you want, and we won’t really know until it’s tested in the field and we see how it performs.”

Ferrara, 34, shared Oliver’s caution and said that no helmet could prevent concussion — all it could do is decrease the chance for one. “You can’t put a seat belt on the brain,” he said.

In general, only about 20 percent of helmets in use by high schools at any one time are less than one year old; a vast majority are reconditioned every one to three years, as budgets permit. Reconditioned helmets are cleaned, receive new bolts and undergo random drop testing to the certification agency’s 1,200 severity-index standard. But the process does little to address the foam padding that degrades over time and provides less protection against the lower-level impacts that cause concussion, according to Dave Halstead, the agency’s technical director.

Horror stories regarding use of deteriorated helmets are not uncommon. Six years ago, Max Conradt, a high school player in Yachats, Ore., was wearing a 20-year-old helmet when he sustained hits that left him comatose for two months and permanently impaired. Halstead said he had seen helmets with padding replaced by athletic socks and with screw points exposed.

Beyond those rare cases, however, Halstead estimated that half of helmets in use at the high school level are either improperly reconditioned, have foam degradation or fit poorly. This leaves them susceptible to the lower-level forces that cause the majority of concussions, rather than the higher grades for which the agency tests. The certification agency does test hockey and lacrosse helmets at both high and low levels — an extra step that Halstead said his organization should strongly consider for football, as more data are collected on its effectiveness.

“There is concern that changing anything about the standards can affect the safety we’ve already attained,” Halstead said. “The unanswered questions are real. But the injuries we see because of concussions are also real, and are becoming more important.”

Ferrara said that internal tests on his helmet’s shock absorbers had shown no notable degradation after hundreds of hits. That, along with the helmet’s promising test scores, have left Cantu imagining uses for the technology beyond football.

“In the military, you have helmets for pilots and ground troops,” said Cantu, who has also advised the Department of Defense on soldiers’ concussions and other brain injuries. “There’s ice-hockey boards and auto-race barriers. Anything that’s protective in nature, that’s used to attenuate energy, could be improved markedly.”

Other companies are attempting to address football’s concussion quandary. Schutt developed a model called the DNA that uses a thermoplastic urethane liner to attenuate energy as well as foam-filled air bladders for fit.

Simbex, a company based in Lebanon, N.H., has developed a tiny accelerometer that fits inside helmet padding, measures sudden movements of the head and can wirelessly alert a sideline trainer. (Riddell now markets a $1,000 helmet with this technology built in.) While by no means foolproof, the device — now in use in eight colleges and four high schools — can help identify when players sustain a particularly dangerous hit but, wanting to stay on the field, attempt to hide it from medical personnel.

And SportSoft, based in Kirkland, Wash., makes tracking stickers similar to labels on grocery items so that equipment managers can better monitor each helmet’s age and reconditioning history.

Ferrara said he wanted his new shock-absorber helmet design to be only one of several lines of defense against concussions. Mindful that previous helmet improvements have occasionally led athletes to feel a false sense of security and take more risks, he said part of his rollout plan would be to emphasize to players and coaches proper, head-up tackling technique, so that the helmet sees fewer dangerous hits to begin with — as well as encouraging athletes to admit when they think they might have a concussion.

“The educational side of it is just as important, if not more important, as the helmet itself,” Ferrara said.

Hawaii quarterback Colt Brennan, a Heisman Trophy contender, was knocked unconscious by a crushing hit three weeks ago. The Oklahoma freshman quarterback Sam Bradford sustained a concussion while being trampled in a game two weeks ago.

Each impact triggered the delicate and controversial process of determining when the athlete is fit to return to the field, both that day and in subsequent weeks. College players operate in a murky zone: their bodies are between youth and manhood, they play in quasi-professional environments on national television — unpaid but with the riches of professional careers dangling before them — and no rules govern how concussions are treated in college football.

Amid much debate about the dangers of concussions, the National Football League has adopted new rules and guidelines for handling the injury. Experts are trying to raise awareness at the high school level, where players appear particularly susceptible to postconcussion syndrome and more serious injuries. At the college level, each team can devise its own procedure for diagnosing and treating concussions.

Hawaii’s Brennan and Oklahoma’s Bradford, both cleared by their team’s medical personnel, will start in crucial games Saturday: Brennan against Washington and Bradford against top-ranked Missouri in the Big 12 Conference championship game. Hawaii and Oklahoma stand to receive millions of dollars if they qualify for an elite bowl game.

Pritchard also has been cleared as Stanford prepares to play Saturday against the University of California at Berkeley, its archrival. But Coach Jim Harbaugh said in a telephone interview yesterday that he had not decided whether Pritchard would start or if T. C. Ostrander, who has started four games this season, will take Pritchard’s place.

Back at the Pritchard home in Lakewood, Wash., Kelli Pritchard, Tavita’s mother, has found herself resisting the urge to get as involved with her son’s care as her instincts tell her. She said that while she trusts Stanford’s medical staff, a part of her knows that a few years ago she would be driving Tavita to his pediatrician and having tremendous influence over his safety.

“I have to be careful that I’m not being condescending and asking questions that are totally inappropriate,” Kelli Pritchard said. “And yet I can’t ever separate myself from being the mama bear.”

Harbaugh said he expected both Pritchard and Ostrander to play Saturday because both are capable and of similar talent. He said he would decide how much each plays, and who starts, solely on how they perform in practice.

“We’ll make that evaluation on who gives us the best chance to win,” Harbaugh said. He added that unless Pritchard displayed the effects of the concussion in practice, which he had not through Tuesday, the injury would not be a consideration. “If there was some kind of postconcussion effect, like being not as accurate with his passes, that would without question impact how much he plays,” Harbaugh said.

Pritchard’s case has been scrutinized heavily both inside and outside Stanford, in part because of a strange series of events in which Pritchard was removed from the Notre Dame game last Saturday but returned for several downs after Ostrander was injured, only to be removed again.

Pritchard’s concussion took place late in the third quarter when he was struck in the helmet after a long scramble. He lay motionless for about 30 seconds before standing up and woozily walking off the field.

Harbaugh said trainers on the sideline gave Pritchard the Standardized Assessment of Concussion test, a 10-minute series of questions that evaluates short-term memory, cognitive awareness and other neurological issues.

“He received a perfect score,” Harbaugh said. Doctors also determined that Pritchard was displaying no physical symptoms of a concussion.

When Ostrander injured his hand midway through the fourth quarter, Harbaugh said he was told by medical personnel that Pritchard had been cleared to play. Pritchard appeared for one series, and took one hard tackle in which his head struck the ground again, before Ostrander returned for the rest of the game.

“The doctors determined that he was cleared to go back in after 10 minutes,” Harbaugh said. “I believe that there definitely should be scrutiny on this. But the other thing that I’m saying is that we have a concussion protocol. Tavita passed that. We have a battery of doctors that were with him from the time he got hit until the time he went back into the game. And that decision is clearly in the hands of the doctors, 100 percent. Coaches don’t make those decisions, and neither do the players.”

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Pritchard said in a telephone interview: “I think it looked worse than it was. It kind of looked like T. C. went down, is Tavita O.K., he’s O.K., and I run in. People need to know that there was a lot more that was done beforehand.”

The question of whether a player who sustains a concussion should ever return to the same game can be divisive. It is strongly discouraged at the high school level because studies have shown that teenagers’ brain tissue is less developed and they are more susceptible to subsequent concussions, which in rare cases can lead to coma or death. (At least 50 high school or younger football players in more than 20 states since 1997 have been killed or have sustained catastrophic head injuries on the field, according to research by The New York Times.)

N.F.L. players, meanwhile, are generally believed to be fit to return if their symptoms have cleared.

Dr. Henry Feuer, who works the sidelines for every home football game for Indiana University and the Indianapolis Colts, and also counsels many of his state’s high schools, agreed with several other experts that college athletes are generally more comparable to professionals than high school players. He also said that most — if not all — Division I programs have formal postconcussion guidelines and testing.

“I feel strongly that teenagers are different, and high schools often don’t have a physician on the sideline,” Feuer said. “In college they almost always do and they have sports-medicine athletic trainers, too.”

Oklahoma’s Bradford sustained a concussion in a Nov. 17 game against Texas Tech, and was removed after telling team personnel that he was forgetting the plays. Scott Anderson, the Sooners’ head athletic trainer, said that Oklahoma used the Automated Neuropsychological Assessment Metrics test, another set of questions that evaluate neurological symptoms, in determining that Bradford should not return to the game.

Bradford was cleared to play the next week. Anderson said he was pleased that Bradford alerted team personnel to his injury because, as opposed to a sprained knee, concussions can be (and often are) hidden by a player who wants to stay in the game.

The injury to Hawaii’s Brennan was obvious — while he was scrambling in the fourth quarter, a Fresno State player hit him at full speed virtually helmet-to-helmet. Brennan was briefly knocked unconscious and did not return. The Hawaii team doctor, Andrew Nichols, declined to be interviewed about how Brennan was cleared to play the following week, on Nov. 16. Last Friday, in a victory against Boise State, Brennan passed for 495 yards and 5 touchdowns.

Brennan had the extra consideration of his professional future. Sustaining another concussion could cost him several spots and millions of dollars in next spring’s N.F.L. draft. Without discussing Brennan specifically, Feuer said that he asks every prospect at the N.F.L. combine about his concussion history.

“You check for easy concussability, and whether it takes them a long time to get back,” Feuer said. “That gets put into their negative column, or whatever, come draft time.”

The last thing Kelli Pritchard said she has considered this week was how Tavita’s sitting out Saturday would affect his N.F.L. future. She speaks with Tavita several times a day on the phone to monitor how he is feeling, but knows that all she can do is hope that her feelings are considered.

“I know a lot is going to go into this decision,” Kelli Pritchard said. “It’s a really hard decision to make for everybody, because everybody’s going to get criticized one way or another.”

Houston mixed martial artist Sam Vasquez died Friday, more than five weeks after he was critically injured in a bout.

He was 35.

Vasquez is the first mixed martial arts fighter to die after suffering injuries in a sanctioned bout. American Doug Dedge died in 1998 after being knocked out in an unregulated fight in the Ukraine.

Vasquez was hospitalized after being knocked out in the third round of a fight against Vince Libardi of San Antonio at the Renegades Extreme Fighting show Oct. 20 at Toyota Center. He lost consciousness and suffered a seizure immediately following the knockout. Vasquez had been in intensive care at St. Joseph Medical Center in Houston before being transferred to a local hospice last Monday.

The Harris County Medical Examiner's Office confirmed Vasquez's death. The cause of death is still to be determined.

"It's a terrible thing; a rare thing," said Lewis Wood, who assisted with preparations for the fight but was not Vasquez's primary trainer. "Obviously, injuries are common, but no one ever expects anything like this to happen. He was the nicest guy in the world. This is a hard one for everyone who knew him."

While hospitalized, Vasquez suffered a massive stroke. According to comments posted by Vasquez's wife, Sandra, to a forum on www.txmma.com, Vasquez was in a medically induced coma and had undergone two surgeries to remove blood clots in his brain. As with all combat-sports bouts sanctioned by the Texas Department of Licensing and Regulation, Vasquez was required to be medically cleared to fight.

Renegades promoter Saul Soliz has been staging professional and amateur shows in Texas since 2000. He had the necessary license from the TDLR to stage the event. Calls to Soliz were not returned.

Sam Vasquez of Houston may have become the first fighter to die from injuries sustained in mixed martial arts competition in North America.

A report by The Fight Network cited the Harris County (Texas) medical examiner's office confirming Vasquez's death at 8:15 p.m. Friday. The cause of death was not released.

Vasquez had been battling for his life since taking a hard right to the chin from 21-year old Vince Libardi on Oct. 20 during a Renegades Extreme Fighting show at the Toyota Center in Houston. The blow knocked Vasquez out and he was rushed to St. Joseph Medical Center, where he stayed until moving to hospice care on Monday.

The 35-year-old Vasquez was competing in the featherweight division (145 pound weight class) in the third match of a 12-match card promoted by Saul Soliz, the longtime boxing coach of Ultimate Fighting Championship superstar Tito Ortiz. The show was overseen by the Texas Department of Licensing and Regulation. Calls to the department on Sunday were not immediately returned.

After taking a flurry of punches from Libardi, Vasquez collapsed in the ring and the fight was waved off at 2:50 of the third round. Emergency medical technicians worked on him in the ring for several minutes until he suffered what appeared to be a seizure and was rushed to the hospital.

Vasquez's condition worsened from there. On Nov. 4, two weeks after being admitted, he underwent the first of two surgeries to relieve the pressure of a large clot in his brain, then had a massive stroke on Nov. 9 and was placed in a medically induced coma.

Vasquez, who had a seven-year-old son, came into the match with a 1-1 record, and had not fought in 13 months. Libardi, 14 years Vasquez's junior, entered the match with seven pro fights and 10 rounds of action over three fights in the time since Vasquez had last fought in Sept. 2006.

"There was nothing out of the ordinary," Paul Erickson, who was at ringside taking photos, said in an interview with The Fight Network. "They scrambled and hit the cage. Sammy stood up and looked a little wobbly. Then he went down and the referee called the doctor in. It didn't seem like anything was out of the ordinary. Sammy was winded and looked exhausted, but he wasn't unconscious when they carried him out. Everyone was puzzled at the time because no one could tell when or where he was injured."

MMA had until recently been considered highly controversial, and a group of critics led by Sen. John McCain caused it to be banned in several states in the mid-to-late 1990s and pressured cable companies to not air its pay-per-view events.

In the past two-and-a-half years, though, the sport exploded in popularity due to television exposure of UFC, the sport's major league franchise. UFC's success has spawned hundreds of smaller promotions around North America with many states now holding more MMA events than boxing events.

Mixed martial arts officials and fans have long noted that there had never been a death in a sanctioned MMA match, a statistic no other combat sport could claim.

The only confirmed death prior to government oversight came when 31-year-old Douglas Dedge of Chipley, Fla. passed away on March 18, 1998, from severe brain injuries suffered in a match two days earlier at a non-sanctioned event called World Super Challenge in Kiev, Ukraine. Dedge had passed out in a training session leading up to the fight, but went through with the match anyway.

Student athletes who return to sports quickly after a concussion appear to have a slower brain recovery than teens who stay off the field longer, a new study shows.The report, from The Journal of Athletic Training, suggests that athletes who suffer from even mild concussions should slow down their return to the sports field. In fact, students with less severe injuries appeared to be those who return to sports the fastest. But resuming intense physical activity appeared to slow their recovery and even exacerbated their symptoms. “By continuing with high levels of activity, they began to exhibit similar symptoms to those who initially experienced a more severe concussion,” said Jason P. Mihalik, an athletic trainer from the University of North Carolina and an author of the study. The researchers tracked the medical records and activity levels of 95 student athletes, including 15 girls, who had suffered concussions in school sports. The students were evaluated using cognitive tests immediately after the concussion and in follow-up visits. The data showed that athletes who engaged in the highest level of activity soon after the initial injury tended to demonstrate the worst neurocognitive scores and slowest reaction times. Students fared better if they didn’t return immediately to their sport but instead simply engaged in normal school and home activities.The study data reflect a general trend showing lower visual memory and reaction scores during the month following the injury among athletes who returned to their sports quickly after a concussion. But the data can’t be used to make specific recommendations about how long students should stay off the field after a concussion, which depends on the extent of the individual injury. However, the study does show that when it comes to concussions, the more time off to heal, the better.Every year there are more than 300,000 sports-related concussions in the United States, and more than 60,000 cases occur among high school students. The study authors said that the results highlight the notion that concussion management may need to include recommendations regarding return to all activities, including school, work and daily chores, and not just sport-specific activities.“Given the health issues associated with concussion, which may last longer than once thought, the decision on when and how to return an athlete not only to the playing field, but also to normal day-to-day activity, has begun receiving attention as a national health issue,” Mr. Mihalik said.Part of the problem is that the culture of student athletics tends to reward students who stay on the field after a head injury, as reported in this Times story. The story is accompanied by this interactive graphic detailing numerous high school sports injuries.And I recommend watching both of the following videos about what can happen when students suffer concussions on the field.

Here is an interesting site doing research in to this:http://sportslegacy.org/It is run (in part) by Chris Nowinski, who was a WWE wrestler who had to stop due to repeated concussions. They now focus on studying brain injury due to athletics. Decent site, nice folks. Scott (Emir/Pencak Silat Sharaf)

Amir Khan searching for remedy after refusing to take defeat on the chin

The Times, October 9, 2008

A boxer can do a hundred abdominal crunches, a thousand press-ups and dance with a skipping rope all day. He can learn the art of attack and defence. But one question, particularly pertinent to Amir Khan, continues to vex even the wisest boxing brains (and that is not an oxymoron) - can anything be done about a glass chin?

“If we knew the answer, that would be like solving the biggest mystery in the history of all boxing,” Emanuel Steward, one of the sport's premier trainers, once said. Angelo Dundee, who guided the great Muhammad Ali, sees no great mystery. “You can't train a chin,” he said, simply.

Yet that is what Khan, 21, will be attempting under the tutelage of Freddie Roach at his Wild Card Gym in Los Angeles when the young Briton heads west next week to rebuild his career. The trainer is devising a series of exercises, based on martial arts techniques, to “deaden the nerves on the jaw”, or at least try to condition them so that one big blow does not again leave Khan resembling a puppet cut loose from its strings. “Is it sound? I'm not sure,” Roach said. “But we've learnt some Thai techniques working with Manny Pacquiao [the Filipino world lightweight champion]. He was suffering with blows to his body, so, using martial arts, he got us to hit him with a stick.“I'm not saying we are going to be hitting Amir Khan with a stick, but there is a belief you can deaden the nerves using pressure, tension, wrestling exercises with the chin on the ground. We'll try and deaden, or toughen, those nerves on the tip of his jaw.”

Most of the time will be spent trying to alter Khan's style so that he is not hit so often and does not suffer the sort of knockout blow that cost him a surprise 54-second defeat by Breidis Prescott in Manchester last month. It was his third knockdown in 19 professional bouts.

But the gym work on Khan's suspect jaw does raise, again, the question of whether a boxer can physically alter his ability to withstand a heavy blow or whether, for better or worse, he is stuck with his chin. “Not every great boxer has a great chin,” Roach said. “It is like a big puncher. They can be improved, but you generally get what you are born with.”

That has not stopped Roach embracing those martial arts techniques, usually employed to toughen up shins and feet for kickboxing and similar disciplines. There have long been theories, their effectiveness unproven, about strengthening the jaw muscles or conditioning the neck.

According to Dr Barry Jordan, a neurologist who was once chief medical officer for the New York State Athletic Commission and has researched boxing's effects on the brain, there are several factors to consider when weighing up why some boxers collapse while others, from George Chuvalo to Antonio Margarito, seem capable of withstanding sledgehammer blows.

Jordan believes that anticipating the punch and possessing strong neck muscles assist a boxer. There is little doubt that Khan not only has a suspect chin but sticks it out, too. “I think he's made mistakes looking for the big knockout because then you put yourself in harm's way,” Roach said. “He started out knocking people down with one punch, but the higher you climb, you need to protect yourself.”

Yet Jordan believes that, while training can make a boxer better able to roll with the punches, the glass chin is a weakness that is handed out at birth. “We know that there is a gene that makes certain boxers liable to neurological impairment over the long term and, while no one has ever conducted detailed research on the effects of one punch, a good chin is about a fighter's genetic predisposition to tolerate punishment,” he said. “In layman's terms, the blow, the sudden acceleration and rotation of the head, causes a disconnection. The ability to withstand that may alter during the career of a boxer.”

But, as far as he can tell, a boxer's tolerance cannot be greatly affected in the gym. If Khan is stuck with this weakness, his best hope is to not get hit, which is why he is spending the next six weeks with Roach. “They say Willie Pep didn't have a great chin, so he changed his style,” Roach said. “And we are talking about one of the greatest boxers of all time. We will be talking to Amir about the way he stands, holds his hands, everything.”

Khan will spar with Pacquiao, the world champion who faces Oscar De La Hoya in December, which should help him to become accustomed to heavy punches and please those who believe that a glass jaw is a matter of heart as much as chin.

No amount of work, though, may solve the abiding mystery of the porcelain jaw. “After that sort of knockdown, some guys roll over and die,” Roach said. “Some get better. Amir seems pretty positive to me, but I really won't know - no one will - until he's back in the ring.”

LARISSA ISSLER Jamieson Kuhlmann, shown in a Facebook photo, was taken off life support on the afternoon of May 21, 2008. Email story Print Choose text size Report typo or correction 15-year-old's death after Monday game leaves sport community reeling in shock

May 22, 2008 04:30 AM Emily Mathieu Staff Reporter

Note: Jamieson Kuhlmann's team was playing Newmarket, not Mississauga, when the fatal injury occurred. Incorrect information was provided to the Star.

An on-field collision during a lacrosse game has resulted in the death of a promising 15-year-old Toronto athlete and devastated his family, friends and members of the city's sporting community.

Jamieson Kuhlmann was fatally injured during a field lacrosse game in Newmarket late Monday afternoon. His Toronto Beaches team was playing against a Mississauga team when the incident happened around 5:30 p.m. It was about five minutes into the first quarter of the game.

Kuhlmann, a left-hander, had just passed the ball up field when a Mississauga player hit him. The player's shoulder and head connected with Jamieson's shoulder and head.

Peter Gibson, a long-time family friend and team trainer, ran onto the field.

"I was the trainer on the team ... his dad asked me to go on the field, so I did," said Gibson.

"He indicated that he felt sick and then he went unconscious. He never regained consciousness from the moment he left the field."

Kuhlmann was transferred to a hospital in Newmarket, then to the Hospital for Sick Children. The decision was made to take him off life support yesterday.

The death of the teen has left the lacrosse community reeling.

"This is unheard of for lacrosse," said John Steele, vice-president of Toronto Beaches Lacrosse Club. "Lacrosse is a very safe sport, very few injuries and admissions to hospital.

"It was a tragic accident."

Steele said the club plans to offer whatever support they can to his family and the community, and plans to offer grief counselling to Kuhlmann's team. "The whole club is shaken by this.

"It's a very sad time."

During a phone interview from the hospital yesterday, Gibson had the sad task of speaking on behalf of a family in mourning.

He has known Kuhlmann's parents Michelle Weber and Mark Kuhlmann since Kuhlmann was a child. His son played on the same lacrosse team; "he's devastated" over the sudden death of his friend, said Gibson.

Kuhlmann was an incredibly passionate, powerful player, said Gibson. Standing at about 5-foot-10 and 175 pounds, he took pride in being in peak condition, something reflected on the field, he said.

Kuhlmann was his parents' only child. They are divorced, his father had remarried and he had two stepsisters. Both his mother and father live in the Beach and presented a united message through Gibson about the nature of their son's death.

"They want the message to be clear that Jamieson died as the result of an accident. The boy that hit him, it wasn't his fault. They really believe it's an accident and there is nothing else than a tragedy."

Gibson went on to describe a charming young man, possessed with a "wry sense of humour," flourishing in school. His family recently made the decision to transfer their son from Malvern Collegiate to The Hill Academy in Kleinburg, a private school with a special focus on sports.

"His mother and father realized he needed that attention and it worked for him ... You could see he was in love with his school work this year."

They invested heavily in their son with whatever emotional and financial support was required to give him an edge in life, he said.

"When you have a child in sports, you are completely involved ... but you do it gladly," he said.

"You go to something like that and your child dies. It's hard to make sense out of any of that. They can't make any sense of that."

His family will be donating his organs. Gibson said the decision is a perfect fit for someone who was so generous and got so much out of life.

"He was a very considerate kid."

The family will hold a private funeral on Monday.

On Tuesday, there will be a celebration of Jamieson's life at the Balmy Beach Club.

IMHO the demands of logic require that we note that there are alternative explanations possible. Football players, especially linemen, eat HUGE amounts of food-- and for many of them much of it may not be very concerned with healthy longevity. IIRC there are correlations with dementia with certain diets. That said, blows to the head are serious and this area deserves our scrutiny and our reflection.

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Dementia Risk Seen in Players in N.F.L. Study

ALAN SCHWARZPublished: September 29, 2009 A study commissioned by the National Football League reports that Alzheimer’s disease or similar memory-related diseases appear to have been diagnosed in the league’s former players vastly more often than in the national population — including a rate of 19 times the normal rate for men ages 30 through 49.

The N.F.L. has long denied the existence of reliable data about cognitive decline among its players. These numbers would become the league’s first public affirmation of any connection, though the league pointed to limitations of this study.

The findings could ring loud at the youth and college levels, which often take cues from the N.F.L. on safety policies and whose players emulate the pros. Hundreds of on-field concussions are sustained at every level each week, with many going undiagnosed and untreated.

A detailed summary of the N.F.L. study, which was conducted by the University of Michigan’s Institute for Social Research, was distributed to league officials this month.

The study has not been peer-reviewed, but the findings fall into step with several recent independent studies regarding N.F.L. players and the effects of their occupational head injuries.

“This is a game-changer — the whole debate, the ball’s now in the N.F.L.’s court,” said Dr. Julian Bailes, the chairman of the department of neurosurgery at the West Virginia University School of Medicine, and a former team physician for the Pittsburgh Steelers whose research found similar links four years ago. “They always say, ‘We’re going to do our own studies.’ And now they have.”

Sean Morey, an Arizona Cardinals player who has been vocal in supporting research in this area, said: “This is about more than us — it’s about the high school kid in 2011 who might not die on the field because he ignored the risks of concussions.”

An N.F.L. spokesman, Greg Aiello, said in an e-mail message that the study did not formally diagnose dementia, that it was subject to shortcomings of telephone surveys and that “there are thousands of retired players who do not have memory problems.”

“Memory disorders affect many people who never played football or other sports,” Mr. Aiello said. “We are trying to understand it as it relates to our retired players.”

As scrutiny of brain injuries in football players has escalated the past three years, with prominent professionals reporting cognitive problems and academic studies supporting a link more generally, the N.F.L. and its medical committee on concussions have steadfastly denied the existence of reliable data on the issue. The league pledged to pursue its own studies, including the one at the University of Michigan.

Dr. Ira Casson, a co-chairman of the concussions committee who has been the league’s primary voice denying any evidence connecting N.F.L. football and dementia, said: “What I take from this report is there’s a need for further studies to see whether or not this finding is going to pan out, if it’s really there or not. I can see that the respondents believe they have been diagnosed. But the next step is to determine whether that is so.”

The N.F.L. is conducting its own rigorous study of 120 retired players, with results expected within a few years. All neurological examinations are being conducted by Dr. Casson.

According to a 37-page synopsis of the study furnished to the league, the Michigan researchers conducted a phone survey in late 2008 in which 1,063 retired players — those who participated from an original random list of 1,625 — were asked questions on a variety of health topics. Players had to have played at least three or four seasons to qualify. Questions were derived from the standard National Health Interview Survey so rates could be compared with those previously collected from the general population, the report said.

Some health issues were reported by N.F.L. retirees at normal rates (kidney and prostate problems), while others were higher (sleep apnea and elevated cholesterol) and others lower (heart attacks and ulcers), the summary said.

The researchers also asked players — or a caregiver for those who could not answer — if they had ever been diagnosed with “dementia, Alzheimer’s disease, or other memory-related disease.”

The Michigan researchers found that 6.1 percent of players age 50 and above reported that they had received a dementia-related diagnosis, five times higher than the cited national average, 1.2 percent. Players ages 30 through 49 showed a rate of 1.9 percent, or 19 times that of the national average, 0.1 percent.

The paper itself questioned the reliability of using phone surveys to assess prevalence rates of diagnosed dementia, as did several experts in telephone interviews. For example, some of those affected may not be reachable; then again, N.F.L. players may have greater access to doctors to make the diagnosis. The lead researcher, David R. Weir, said in an interview that proxies might have been handled differently in past studies.

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“This suggests something suspicious,” said Dr. Amy Borenstein, professor of epidemiology at the University of South Florida. “But it’s something that must be looked at with a more rigorous study.”

Dr. Daniel P. Perl, the director of neuropathology at the Mount Sinai School of Medicine in New York, agreed with Dr. Borenstein but described the Michigan work as significant. “I think this complements what others have found — there appears to be a problem with cognition in a group of N.F.L. football players at a relatively young age,” he said.All rates appear small. But if they are accurate, they would have arresting real-life effects when applied across a population as large as living N.F.L. retirees. A normal rate of cognitive disease among N.F.L. retirees age 50 and above (of whom there are about 4,000) would result in 48 of them having the condition; the rate in the Michigan study would lead to 244. Among retirees ages 30 through 49 (of whom there are about 3,000), the normal rate cited by the Michigan researchers would yield about 3 men experiencing problems; the rate reported among N.F.L. retirees leads to an estimate of 57.

So the Michigan findings suggest that although 50 N.F.L. retirees would be expected to have dementia or memory-related disease, the actual number could be more like 300. This would not prove causation in any individual case, but it would support a connection between pro football careers and heightened prevalence of later-life cognitive decline that the league has long disputed.

After the University of North Carolina’s Center for the Study of Retired Athletes published survey-based papers in 2005 through 2007 that found a correlation between N.F.L. football and depression, dementia and other cognitive impairment, a member of the N.F.L. concussion committee called the findings “virtually worthless.”

After initiating a fund in 2007 that provides financial assistance to retirees receiving care for dementia, the league insisted that it was doing so only because the disease “affects many elderly people” well beyond N.F.L. players. And a pamphlet that the league gives every player about concussion risks states, “Research is currently under way to determine if there are any long-term effects of concussion in N.F.L. athletes.”

“It’s time to edit that brochure,” said Kevin Mawae of the Tennessee Titans, the president of the N.F.L. Players Association. “Now it’s in their words and not just other people’s.”

Published: October 23, 2009 When a survey commissioned by the National Football League recently indicated that dementia or similar memory-related diseases had been diagnosed in its retired players vastly more often than in the national population, the league claimed the study was unreliable.

But confidential data from the N.F.L.’s dementia assistance plan strongly corroborates claims of a link between football and later-life cognitive impairment. Records indicate that pro football’s retirees are experiencing moderate to advanced early-onset dementia at rates several times higher than the general population, the most glaring evidence to date of the dangers of professional football in past eras.As the House Judiciary Committee prepares to hold a hearing on Wednesday on the issue of brain injuries in football, this latest data further underscores the possible safety risks of the modern game at all levels, from the N.F.L. to youth leagues.

The new information was collected by a lawyer for the 88 Plan, which the league and its players union began in 2007 to reimburse medical expenses of retirees being treated for dementia, and was presented to the union in a memorandum, which was obtained by The New York Times. The lawyer, Douglas W. Ell of the Groom Law Group, compared the age distribution of 88 Plan members with several published studies regarding dementia rates around the world, and wrote that “the numbers seem to refute any claim that playing N.F.L. football substantially increases” later risk for dementia.

But the outside data on which he primarily based this conclusion was not only mishandled — the wrong numbers were taken from one published study, grossly overstating worldwide dementia rates — but the analysis also included several faulty assumptions, experts said in later interviews. Correcting for these errors indicated rates of dementia among N.F.L. retirees about four to five times the expected rate.

“This was a preliminary effort at the request of the union to understand the facts,” said Ell, adding that he was acting as a lawyer for the union. “I understand now that it was flawed. I believe the union wants the true facts to come out and welcomes inquiries into this area.”

Joe Browne, an N.F.L. spokesman, said in an e-mail message that because no one at the league office had yet seen Ell’s analysis, it was phantom.

“I say phantom because we have not seen this analysis in our office and, if it was done, it obviously was written for the N.F.L. player union’s own self-promotional and lobbying purposes in anticipation of next week’s Congressional hearing,” Browne wrote.

“The executive director has made it clear that player safety is too important to be about business as usual, the N.F.L.’s special interests or our special interests,” George Atallah, a union spokesman, said, referring to the new union chief, DeMaurice Smith. “This issue is and will always be only about the players, and we have to obtain the right information to get the right answers. The executive director has directed that all information on player health and safety be exchanged with the N.F.L., with the hope that they will do the same.”

As brain injuries in football have come under scrutiny in recent years, and as several independent academic studies have found high rates of cognitive decline among N.F.L. retirees, the league and its committee on concussions have consistently denied the existence of credible evidence supporting any link. When a telephone survey conducted by the University of Michigan on behalf of the N.F.L. recently reported that its retirees aged 50 and above reported diagnoses of cognitive disease at five times the rate of the national population, the league said such surveys were unreliable.

Members of the 88 Plan, however, are dementia cases that the league itself has confirmed as diagnosed by a physician and incurring expenses worthy of reimbursement. As such they represent a minimum of existing cases — even Commissioner Roger Goodell has acknowledged that there are more candidates either unreachable or unwilling to apply — as well as a severity of disease that is undoubtedly higher than cases in common literature, experts said.

“You know N.F.L. players,” Goodell said when asked about the 88 Plan at his annual news conference before last season’s Super Bowl. “They’ve got a lot of pride. When they have a lot of pride, they don’t always want to become public with their needs.”

According to Ell’s memorandum, 68 men ages 60 to 89 were receiving plan aid as of Oct. 1. (About 35 others had been admitted and died.) Ell then assessed how many plan members would be expected if N.F.L. retirees in various age groups experienced dementia at rates published in six academic studies. The analysis from there was faulty, however.

Only four of the six studies included any data on men in their 60s, whose dementia would be defined as early-onset. One yielded an expectation of 58 dementia cases among the N.F.L. population, another about 40. One included crude estimates from Scotland, which, after Ell further applied them improperly to the N.F.L. population — he didn’t stratify them by age — yielded an estimate of over 200. The fourth included two obvious errors: the wrong column of published data was used, and those numbers were not rates per 100 but rates per 1,000. Ell’s resulting estimate, 135, which he interpreted along with the Scotland figure as balancing the lower figures, should have been 73.

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The 88 Plan’s living membership (68) looks similar to the three expectations of 58, 40 and 73. But experts in dementia epidemiology and health policy said in interviews that the 68 was far more alarming than at first glance.

"These are apples and oranges,” said Amy Borenstein, professor of epidemiology at the University of South Florida, who specializes in dementia research. “You can’t directly compare that plan’s numbers to any population-based study.”First, as Goodell asserted, the program cannot include veterans who are unreachable or unwilling to apply. One unwilling player appears to be Rayfield Wright, 64, a Hall of Fame tackle for the Cowboys from 1967 to 1979 who lives in the Dallas area.

His friend and caregiver, Jeannette DeVader, said that Wright had all the signs of early-onset dementia — including short-term memory loss and frequently getting lost — but that he would not see a neurologist, let alone apply to the 88 Plan. Wright confirmed that he did not want what he called the stigma: “Players don’t want to look at themselves that way. The truth is, you really don’t want to know.”

The wife of one player experiencing early-onset dementia, who asked not to be identified, said she would not apply for the 88 Plan while her husband was coherent enough to understand it.

“He would be devastated,” she said. “They were so proud as players. They’re not going to admit any weakness now, and I’m not going to break his heart by doing it for him.”

Borenstein said that it was reasonable to conclude that if 68 men ages 60 to 89 are receiving aid from the 88 Plan, at least 40 or 50 more cases of similar severity are unaware of the program, unwilling to apply or do not need financial aid. This estimate was echoed by other experts in dementia and epidemiology, including Dr. Daniel P. Perl of the Mount Sinai School of Medicine in New York and Dr. Robert C. Cantu, co-director of the Center for the Study of Traumatic Encephalopathy at Boston University.

In addition, according to those doctors and published studies, about half of people with dementia are considered mild cases, many of whom were unaware they had the condition before and after a study was performed. “It’s hard to believe that more than a few 88 Plan members are in what we call the mild category,” Perl said, given the anecdotal evidence and financial data the N.F.L. released this month.

The league said $6 million has been distributed to 106 members in the two-plus years the 88 Plan has been in place; given that they have received aid for various periods, that leads to more than half of members receiving $40,000 to $88,000 maximum per year in aid — suggesting full-time at-home or institutional care, Borenstein and Perl said.

And some of the cases receiving low levels of aid are advanced: Sharon Hawkins will place her 71-year-old husband, the former Oakland Raiders lineman Wayne Hawkins, in a full-time facility next week after receiving less than $10,000 per year from the 88 Plan since 2007.

“He gets lost walking the dog,” Sharon Hawkins said. “Thank God the dog has known the way home.”

Borenstein, Perl and Cantu said that if academic studies predicted about 60 N.F.L. veterans to have dementia across the full severity spectrum, which is the case here, only about 20 to 30 would be experiencing the severity that appears in the 88 Plan.

Combining the two major differences between the N.F.L. data and estimates for the general population — only about 25 men should have dementia to that degree, the researchers reasoned, and there are probably about 110 who do — leaves former N.F.L. players experiencing dementia at rates four to five times more often than normal.

“We’re talking about a four-, four-and-a-half-fold increase — that’s substantial,” Perl said. “Playing football for as long as these men have, there’s no other environmental risk factor of that magnitude. There are some assumptions here, yes. The comparability of general population rates are not exact. But those assumptions are reasonable. Maybe it’s three times. Maybe it’s five. But these data suggest that something very serious is going on here.”

In his e-mail message, Browne of the N.F.L. wrote: “According to the literature, dementia has many different causes, e.g., a stroke, as the result of substance abuse or family history. It also can be caused by a series of blows to the head or a severe head trauma years after a player has ended his career.”

Browne’s list notably did not include N.F.L. play. His skepticism was shared earlier this year by Dan Rooney, the owner of the Pittsburgh Steelers.

“I believe that our statistics are very similar to what they are in the general population,” Rooney said after Goodell’s news conference. “I don’t think that it’s something that pro football players, every one of them has this. Surely there’s something about getting hit. But they don’t get hit as much as maybe some people are trying to say.”

New Research Says Small Hits Do Major Damage—and There's Not Much Headgear Can Do About ItBy REED ALBERGOTTI and SHIRLEY S. WANG

This football season, the debate about head injuries has reached a critical mass. Startling research has been unveiled. Maudlin headlines have been written. Congress called a hearing on the subject last month.

As obvious as the problem may seem (wait, you mean football is dangerous?), continuing revelations about the troubling mental declines of some retired players—and the ongoing parade of concussions during games—have created a sense of inevitability. Pretty soon, something will have to be done.

But before the debate goes any further, there's a fundamental question that needs to be investigated. Why do football players wear helmets in the first place? And more important, could the helmets be part of the problem?

"Some people have advocated for years to take the helmet off, take the face mask off. That'll change the game dramatically," says Fred Mueller, a University of North Carolina professor who studies head injuries. "Maybe that's better than brain damage."

The first hard-shell helmets, which became popular in the 1940s, weren't designed to prevent concussions but to prevent players in that rough-and-tumble era from suffering catastrophic injuries like fractured skulls.

But while these helmets reduced the chances of death on the field, they also created a sense of invulnerability that encouraged players to collide more forcefully and more often. "Almost every single play, you're going to get hit in the head," says Miami Dolphins offensive tackle Jake Long.

What nobody knew at the time is that these small collisions may be just as damaging. The growing body of research on former football players suggests that brain damage isn't necessarily the result of any one trauma, but the accumulation of thousands of seemingly innocuous blows to the head.

The problem is that there's nothing any helmet could do to stop the brain from taking lots of small hits. To become certified for sale, a football helmet has to earn a "severity index" score of 1200, according to testing done by the National Operating Committee on Standards for Athletic Equipment, or Nocsae. Dr. Robert Cantu, a Nocsae board member and chief of neurosurgery at Emerson Hospital in Concord, Mass., says that to prevent concussions, helmets would have to have a severity index of 300—about four times better than the standard. "The only way to make that happen, Dr. Cantu says, "is to make the helmet much bigger and the padding much bigger."

The problem with that approach, he says—other than making players look like Marvin the Martian—is that heavier helmets would be more likely to cause neck injuries.

One of the strongest arguments for banning helmets comes from the Australian Football League. While it's a similarly rough game, the AFL never added any of the body armor Americans wear. When comparing AFL research studies and official NFL injury reports, AFL players appear to get hurt more often on the whole with things like shoulder injuries and tweaked knees. But when it comes to head injuries, the helmeted NFL players are about 25% more likely to sustain one.

Andrew McIntosh, a researcher at Australia's University of New South Wales who analyzed videotape, says there may be a greater prevalence of head injuries in the American game because the players hit each other with forces up to 100% greater. "If they didn't have helmets on, they wouldn't do that," he says. "They know they'd injure themselves."

Dhani Jones, a linebacker for the Cincinnati Bengals who has played rugby, too, says head injuries in that sport do happen, but they're mostly freak accidents. "In football, you're taught to hit with your face," he says. "You're always contacting with your 'hat,' which is your head."

Taking away helmets might have other benefits for the sport. It would bring down the cost of equipment, which can be crippling for some schools. A slower game might also be more palatable to some parents. And with their heads uncovered, football players might be more attractive to endorsers.

By all accounts, banning helmets isn't on anyone's agenda. Greg Aiello, a spokesman for the NFL, says the league isn't contemplating the idea. Its focus is on improving helmet technology and on rules "that help take the head out of the game." Not wearing helmets, he says, "is not going to eliminate the risk of concussion in a sport that involves contact." Dr. Thom Mayer, a medical adviser to the NFL players' union, says there isn't enough research showing that playing without helmets would reduce brain injury. "It's an interesting theoretical question, but I don't think anybody would consider playing NFL football without a helmet," he says.

Larry Maddux, the head of research and development for helmet-maker Schutt, says even without helmets, players would inadvertently get hit in the head—and regular knocks and bumps could turn into concussions. Thad Ide, the vice president of research and development at Riddell, the NFL's official helmet sponsor, says getting rid of helmets would be a bad move. "There would always be incidental contact," he says.

So what should be done?

Julian Bailes, a neurosurgeon who has conducted brain research for the players' union, says the NFL should change the rules so linemen aren't allowed to go into three-point stances before plays—a rule that would prevent them from springing head-first into other players. He says he would also stop all head contact in football practices. Dr. Cantu says brain injuries could be reduced by enforcing rules already on the books in the NFL—especially helmet-to-helmet hits, which are not always called by officials. "There have to eventually be some hard sanctions for referees," he says.

To many, the solution is to come up with a better helmet. The NFL is currently conducting independent testing of helmets with a focus on "more accurate and comparative information about concussive forces," says neurologist Ira Casson, a co-chair of the NFL's Mild Traumatic Brain Injury Committee.

In the past, attempts to create a better helmet haven't met with much success. Robert Cade, who is better known as an inventor of Gatorade, created a shock-absorbing helmet that was used by a number of NFL players in the 1970s. In the late 1980s, Bert Straus, an industrial designer, came up with the ProCap, a soft outer shell that fits over helmets to help absorb blows. It was also used by some NFL players but also never caught on.

Nonetheless, the strongest argument for the helmet may turn out to be an economic one. The NFL is shaped around the notion that players can run into each other at high speeds without consequence. It's the same sort of idea that has made Nascar the nation's most popular form of motorsport. And beyond all this, there's the very real question of whether the prospect of serious mental impairment later in life will ever discourage people from playing the game—let alone watching.

"Without the helmet, they wouldn't hit their head in stupid plays," says P. David Halstead, technical director for the Nocsae, the group that sets helmet-safety standards. But without helmets, the game "wouldn't be football," he says.

By ALAN SCHWARZPublished: November 22, 2009 In a shift in the National Football League’s approach to handling concussions, the league will soon require teams to receive advice from independent neurologists while treating players with brain injuries, several people with knowledge of the plan confirmed Sunday.

For generations, decisions on when players who sustain concussions should return to play have been made by doctors and trainers employed by the team, raising questions of possible conflicts of interest when coaches and owners want players to return more quickly than proper care would suggest. As scientific studies and anecdotal evidence have found a heightened risk for brain damage, dementia and cognitive decline in retired players, the league has faced barbed criticism from outside experts and, more recently, from Congress over its policies on handling players with concussions.

The league and Commissioner Roger Goodell have insisted that the N.F.L.’s policies are safe and that no third-party involvement is necessary, pointing to research by its committee on concussions as proof. But after an embarrassing hearing on the issue before the House Judiciary Committee last month in which the league was compared to the tobacco industry, the N.F.L. seems to have begun to embrace the value of outside opinion.

“I don’t want to call it forced, but it’s been strongly urged because of the awareness of the issue these days,” Chester Pitts, a lineman and union representative for the Houston Texans, said in a telephone interview. “When you have Congress talking about the antitrust exemption and them calling them the tobacco industry, that’s pretty big. But it’s a good thing it’s transpiring.”

The league spokesman Greg Aiello offered no details of the new guideline, first reported Sunday on Fox’s N.F.L. pregame broadcast, like when it will go into effect, how the independent doctors will be identified and compensated, or even whether their input must be followed.

But Mr. Goodell, interviewed Sunday on the NBC program “Football Night in America,” referring to the use of independent doctors for concussion cases, said: “As we learn more and more, we want to give players the best medical advice. This is a chance for us to expand that and bring more people into the circle to make sure we’re making the best decisions for our players in the long term.”

George Atallah, the players union’s assistant executive director for external affairs, said in an e-mail message that his organization had been speaking with N.F.L. officials for two weeks about implementing some sort of independent scrutiny for players who receive concussions — perhaps including an outside doctor present at every game. He said that the union’s medical director, Dr. Thom Mayer, “has personally approved and reviewed doctors for roughly one-third of the teams,” suggesting that the union would cooperate on the program.

Mr. Atallah said he did not know when the policy might take effect.

Mr. Atallah added that the union had pushed for the program “with the hope that this example spreads to every level of football.” More than 1.2 million teenagers play high school football every fall, with many getting seriously injured by playing through concussions or not having proper medical care for them.

At the House Judiciary Committee hearing on football brain injuries last month, several members of Congress portrayed Mr. Goodell and the league as impeding proper player care and obfuscating the long-term effects of concussions. The league and a co-chairman of its committee on brain injuries, Dr. Ira Casson, have consistently played down studies and anecdotal evidence linking retired N.F.L. players to brain damage commonly associated with boxers and dementia rates several times that of the national population.

Regarding the care of current players who sustain concussions, in 2007, the league enacted measures that required all players to undergo baseline neuropsychological testing and then be retested before being cleared to play; forbade players who were knocked unconscious to return to play the same day; and set up a hot line through which players could report being pressured to play against a doctor’s advice.

The hot line was in response to the story of Ted Johnson, a former New England Patriots linebacker who said he was coerced by Patriots Coach Belichick into playing too soon after a concussion, and sustained a more serious injury that led to a debilitating case of postconcussion syndrome. (Belichick denied the accusation.) Requiring an independent doctor at games or for follow-up consultation would protect against similar incidents that players say are less overt but nonetheless prevalent in a league without guaranteed contracts.

An independent doctor cannot address what many experts consider the primary area needing reform: the tendency of players who sustain concussions to hide them from medical personnel and endanger themselves. Even Sean Morey, a special-teams player for the Arizona Cardinals who is a co-chairman of the union’s committee on brain injuries, admitted this season that he played a game despite a concussion.

Consulting doctors beyond the team does not necessarily solve all of the league’s conflict-of-interest issues. And it is unclear how guidelines would define who is an independent expert.

The most prominent current — and instructive — N.F.L. concussion is probably that of the Philadelphia Eagles running back Brian Westbrook. He sustained one major injury Oct. 26, was held out of the next two games by team doctors, and then sustained another concussion Nov. 15.

Given that repetitive concussions are known to cause far more damage than single injuries, the Eagles sent Westbrook to well-regarded concussion specialists at the University of Pittsburgh Medical Center last week for a third-party examination. Complicating matters could be that the Pittsburgh group includes the Steelers’ team neurosurgeon as well as the league’s director of neurological testing.

By ALAN SCHWARZPublished: November 24, 2009 In the latest indication that the National Football League will redirect its approach to players’ concussions, the co-chairmen of the league’s committee on brain injuries resigned from the group Tuesday, the league announced.

Dr. Ira Casson and Dr. David Viano, members of the committee since 1994 and co-chairmen since 2007, co-authored most of the group’s published research papers whose conclusions regarding head injuries were met with considerable criticism from medical peers. Casson has been the league’s primary voice discrediting all evidence linking football players with subsequent dementia or cognitive decline, drawing criticism from fellow scientists, players and ultimately Congress.In a memo to all teams on Tuesday in which he outlined several measures regarding concussions, Commissioner Roger Goodell said that Casson and Viano would “continue to assist the committee,” but offered no details of any future relationship. A league spokesman confirmed that Casson and Viano would no longer be official members of the committee.

“The N.F.L. is currently identifying their replacements and additional members who will bring to the committee independent sources of expertise and experience in the field of head injuries,” Goodell said.

On Sunday, the league confirmed that it is collaborating with the players union to identify independent neurologists to work with team medical staffs to treat players with brain injuries.

This is the second time that the league has replaced leadership of its committee on concussions. In early 2007, the chairman, Dr. Elliot Pellman, resigned after strong criticism of his work and indications that he had exaggerated several aspects of his medical education and professional status in official biographical sketches and a résumé prepared for Congress. He was replaced by Casson and Viano.

Messages left for Casson, a neurologist at Long Island Jewish Medical Center, and Viano, an adjunct professor of engineering at Wayne State University in Detroit, were not immediately returned.

“This is a step in the right direction,” George Atallah, the players union’s assistant executive director for external affairs, said. “We look forward to working with the league to produce a more detailed and firm plan regarding the protection of players.”

As scientific and anecdotal evidence of football brain injuries’ long-term effects grew in prominence in recent years, Casson dismissed outside studies that identified links to dementia and other cognitive decline, citing only their limitations and never their significance. He contended that the league’s continuing study of retired players, which independent experts said had significant statistical limitations and in which he was conducting all neurological examinations, would deliver the first meaningful data on the issue.

In January, when experts at Boston University found that a sixth deceased N.F.L. veteran had developed extremely rare trauma-induced brain damage before the age of 50, Casson responded, “It’s very hard to know if there’s any significance until things are presented in the appropriate scientific manner.” He added, “They might be significant, they might not be.”

In September, when a league-sponsored telephone survey found that N.F.L. retirees were reporting diagnoses of dementia and other memory-related diseases at several times the rate of the national population, Casson said, “What I take from this report is there’s a need for further studies to see whether or not this finding is going to pan out.”

“Dr. Casson already had his conclusions drawn before the study was concluded that there was no link between cognitive decline and concussions,” said Representative Linda Sanchez, Democrat of California, who highlighted Casson’s involvement at the Judiciary Committee hearing. “Whoever replaces him should be more apt to apply information from the other studies that are out there.”

The resignations of Casson and Viano cast doubt on the future of the league’s continuing study of retired players. Because Casson personally conducted the neurological examinations of the roughly 60 players (of ultimately 180) that were to be studied, that data will not have the proper integrity, Sanchez said.

“I would call for the N.F.L. to start from scratch, and to make changes to how they’re conducing the study to conform to other aspects of academic studies,” she said.

Viano, along with Casson, was at one point publicly criticized by his own colleagues. The two changed the conclusion of one of the papers they submitted to the journal Neurosurgery without alerting its other co-authors. In the altered section, Viano and Casson wrote that “it might be safe” for high schools to consider the N.F.L.’s practice of allowing players who sustain concussions to return to the same game.

That practice is known to court dangerous consequences in teenagers.

When informed of the change two years later and hearing how the paper had been said to impede proper care of players at the youth level, two of the co-authors were furious.

Casson and Viano stood by their decision. Casson responded: “This paper was aimed at scientists and physicians. If people who are not scientists or physicians are misunderstanding it, then that is not the responsibility of those of us who wrote it.”

Casson’s statements while representing the N.F.L. ultimately raised eyebrows in Congress. When Sanchez learned in September that Casson was overseeing the N.F.L.’s retired player study — and conducting all patient exams personally — she accused the league of conducting research like the tobacco industry.

Casson replied: “I assume that the Congresswoman was not a scientist and not a physician. She is not an expert.”

Sanchez responded by providing the most theatric moment of the Oct. 28 hearing, playing a videotape of an HBO reporter asking Casson whether football had any long-term effects on the brain. “In N.F.L. players? No,” Casson said flatly. As Sanchez noted that Casson was not present to testify himself, it became an indelible image of the hearing.

Casson appeared on CNN later that night, but has receded from public view since.

Most critics said that their primary concern with the N.F.L.’s handling of concussions and research into them was that it often misled the public about the seriousness of football brain injuries.

More than one million youngsters play high school football every fall, with hundreds seriously injured by concussions — often by either not understanding the risks or playing through pain like their N.F.L. heroes.

In the N.F.L.’s announcement Tuesday, Goodell identified other measures designed to improve player safety regarding brain injuries.

He said the independent doctors that the league and the players union were assembling to evaluate players with concussions would have to clear any player before he returned to a game or practice.

Goodell also said that on Dec. 10 the league would begin showing a public-service announcement on head injuries, a strong recommendation of several members of Congress a month ago.

By ALAN SCHWARZPublished: November 25, 2009 Andre Waters, a former N.F.L. defensive back, put a pistol in his mouth, pulled the trigger and — however unknowingly — sounded an alarm on the seriousness of football brain injuries.

It was November 2006. A neuropathologist soon discovered extensive damage in Waters’s brain tissue. For the next three years, as similar cases came to light and the hideous effects of football brain trauma were examined in newspaper articles, television features and one heated Congressional hearing, the N.F.L. and its committee on concussions vehemently fought suggestions that their approach to the injury was at all improper.The debate did not end on Tuesday, when the league announced several measures that most onlookers called long overdue. The embattled co-chairmen of the league committee resigned — “graciously,” Commissioner Roger Goodell said in a leaguewide memo, suggesting that they would have been fired otherwise. And the N.F.L. affirmed its plan to install independent experts to bring an uncompromised approach to handling players with concussions.

But the affair did reach a moment of reflection. Even the most hardened skeptics who had fought the league’s approach for years sensed that Tuesday was a moment for détente. Chris Nowinski, a former Harvard football player and the primary advocate for reform in the treatment of sports concussions, joined others involved with the issue in calling Tuesday’s events the most significant since Waters killed himself.

“It means that possibly the most public voice on this issue, the N.F.L., has decided to stop blocking progress and maybe become part of the solution,” Nowinski said.

“Not just the co-chairs resigning, but the message aimed at children, parents and coaches — saying that there’s a problem that needs to be addressed now — will go a long way to protecting kids and players in the future,” he said. “I think it refocuses what’s important, which is developing ways to prevent brain damage in current and future athletes, and treating people who have already been touched by the problem.”

Tempering some optimism was how the N.F.L. announcement — which included the consideration of changes to practice and game rules and the plan for a televised public-service announcement on concussions to make its debut next month — employed much of the same obfuscatory language as dozens of past league statements on the issue.

The release quoted Goodell as saying that the moves would “enhance the substantial progress we have made in recent years” and that “our goal remains to make our game as safe as possible, protect the health and safety of our players, and set the best possible example for players at all levels and in all sports.” The league spokesman Joe Browne wrote on Twitter, “Goodell again shows he’s serious re: concussions.”

This continued a pattern of the league requesting credit for improving conditions without accepting its role in preserving the conditions that required improvement. For example, when the N.F.L. decided in 2007 that players who were knocked unconscious during games could no longer return the same day, the league did not address how published research by its own committee doctors had declared the practice safe. And on the day that Goodell held a leaguewide concussion summit in June 2007 to show how serious the league was on the issue, he fought the suggestion that a player found with brain damage similar to Waters’s had developed it through football.

Goodell insisted that the player “may have had a concussion swimming,” adding, “A concussion happens in a variety of different activities.”

Industries with $8 billion in revenue generally do not court lawsuits, so few onlookers expected the N.F.L. to embrace the suggestion that its past or current practices were subpar. (For example, a player who was cleared to play after being knocked unconscious could attempt to prove he was knowingly mistreated.) But the league took a serious public-relations hit in the meantime, according to Marina Ein, a crisis management specialist based in Washington.

“They were dragged kicking and screaming, when we’re talking about people dying young and losing their cognitive lives,” Ein said. “The resistance to the problem and the cover-up always leads to tragedy and a crisis that ought never to happen. How many players have been submitted to potentially life-altering injuries in the last three years, since the issue was really raised prominently?”

Incongruously, a study that the league commissioned — but immediately discredited — led directly to Tuesday’s events. A University of Michigan phone survey, obtained by The New York Times in September, indicated that N.F.L. retirees were reporting diagnoses of dementia and other cognitive diseases at rates many times the national average.

The league and its doctors dismissed the findings, but news media coverage prompted the attention of Congress, whose hearing on Oct. 28 led to public comparisons between the N.F.L. and the tobacco industry. It took less than a month for Goodell to act more decisively than ever before.

If the league does follow through with meaningful independent care of player concussions, and does actually enact rule changes rather than merely discuss them, the burden of protecting players will continue to shift to the players. As the league has claimed that “all return-to-play decisions are made by physicians,” all involved know that is false; most players with concussions decide to keep playing without a physician’s even knowing, or even having reason to know.

Coaches and the news media will also share responsibility not to glorify “warriors” who get back on the field quickly, and independent research into what can help stem football’s high rates of dementia and other cognitive decline will need funding.

“We’ve failed as a nation to look at this very serious issue,” said Jim Kovach, a former N.F.L. linebacker who is president of the Buck Institute for Age Research near San Francisco. “It has to be all of us looking at this and saying that these could be our kids or friends getting hurt. It’s not just the N.F.L.”

But on Tuesday, as the N.F.L. shed some of its past and announced better care in the future, it was the N.F.L. giving all sides a chance to start a more cooperative era.

“There’s always the possibility of a fresh start,” said Ein, the crisis management specialist. “That’s the beauty of doing the right thing.”

Miami, FL, United States (AHN) – A man was punched in the head and died when he fell to the ground after he refused to give another man a cigarette, according to Miami police.

Linsey Oliveira, 26, of Boca Raton, FL was walking to a club with another friend in downtown Miami when a man approached the two and asked for a cigarette. Oliveira’s friend told the man they did not have any cigarettes, and the two men continued walking. The man walked behind Oliveira and his friend and punched Oliveira in the head, causing him to stumble and hit his head on the pavement, according to reports. He was rushed to Jackson Memorial Hospital’s Ryder Trauma Center, where he died.

On Sunday afternoon, more than 28 million people were watching Fox’s national broadcast when the Philadelphia Eagles’ Stewart Bradley rose woozily, stumbled and then collapsed onto the turf. The Fox announcers Joe Buck and Troy Aikman expressed concern and even horror. Players waved frantically for medical assistance.

David Maialetti/Philadelphia Daily NewsEagles Coach Andy Reid, left, checking on linebacker Stewart Bradley during the second quarter. Bradley returned to the game less than four minutes after collapsing on the field. Less than four minutes later, Bradley, a linebacker, was sent back into the game.

Only at halftime was his injury diagnosed as a concussion.

The Eagles said afterward that they did not permanently remove Bradley at the time of his injury — per new N.F.L. rules — because their sideline exam revealed no concussion and also because no medical person saw either the hit Bradley took or his collapse to the turf.

Considering that doctors and trainers are well represented on N.F.L. sidelines and that the league has made concussion awareness an issue this season, the Eagles’ handling of Bradley’s injury raises a stark question: If a concussion this glaring can be missed, how many go unnoticed every fall weekend on high school and youth fields, where the consequences can be more serious, even fatal?

According to the National Athletic Trainers’ Association, only 42 percent of high schools in the United States have access to a certified athletic trainer, let alone a physician, during games or practices. In some poorer rural communities, concussed players are taken to doctors with no experience with head injuries. Youth leagues with players as young as 8 and 9 rarely, if ever, have any medical personnel on hand; when a child is hurt, a parent, assuming one is present, walks out on the field, scoops up the child and carries him or her off.

The cost of hidden head trauma among children was driven home Monday, also in Philadelphia, as a University of Pennsylvania lineman who hanged himself in April, Owen Thomas, was found to have died with the same progressive brain disease found in more than 20 N.F.L. players. Playing since age 9, Thomas never had a reported concussion; his disease silently developed either through injuries he did not report or by thousands of subconcussive blows that accumulated over time.

Research suggests that 10 percent to 50 percent of high school football players will sustain a concussion each season, with as many as 75 percent of those injuries going unreported and unnoticed.

“Here in Rhode Island we have a state law that an athletic trainer must be at contests, but most schools are in violation,” Dr. John P. Sullivan, the University of Rhode Island’s sports psychologist, wrote in an e-mail Tuesday. “The risk is real.”

Dawn Comstock of Nationwide Children’s Hospital in Columbus, Ohio, is the nation’s principal researcher of injuries among all high school athletes, having overseen the collecting of data that suggest about 70,000 concussions occur each year in high school football. Those that are reported, that is.

“We have very little about what happens to high school brains during these hits,” Comstock said. “We have no idea at all what’s happening in kids’ brains while they’re on the youth field or community rec field.”

There have been improvements in the three years that concussions have received national attention. More than a dozen states have passed laws requiring education for coaches and requiring clearance from an appropriate medical professional before a child is allowed to return to his or her sport. (The laws often cover only public schools, however.) At Norman High School in Oklahoma last month, when a sophomore walked into the coach’s office and asked if he could try out for the team, within 15 seconds he was handed a two-page information sheet regarding concussions that he and his parents had to sign before he could play.

Acknowledging the league’s impact on young athletes, the N.F.L. asked a skeptical Congress and public to view its protocol changes last year as proof of its commitment to lead concussion awareness efforts.

N.F.L. players now must be removed for the rest of the day after a concussion is diagnosed; an independent doctor must clear the player before he can return; and a new poster warns players of head injuries with stunningly strong language. That placard even concludes, “Young Athletes Are Watching.”

Yet, when the entire football world saw the Eagles put Bradley at significant safety risk by not properly diagnosing his concussion, it only emphasized the crisis that exists in high school and youth football, where almost no one is watching at all.

Last year, the N.F.L. requested and received praise for producing the first public-service announcement geared toward educating young players about the dangers of concussions. This week it has delivered a different, less scripted, message.

I fight in armor with sword and shield. My helm is made of of 12 gauge steel and the sticks are 1 1/4" rattan. The choice of steel and weapon thickness has to do with maintaining sufficient adrenalin factor while still being relatively safe. The mass of the helmet slows down the impact. The padding immediately inside the helm is neoprene followed by an inner cap of open cell foam that allows the helm to "float" around my head. The sticks that we use pack enough of a wallop that you can still get your bell rung through a helmet like that. When you get hit hard, you can feel the shock of the hit first moving the helmet and then causing your head to move as the padding presses into you. It can cause a headache to get hit like that. I do not know how getting hit with less stout sticks in a saber mask compares. It looks worse. It certainly seems to cause more peripheral damage to the skin and head. And I assume you get a headache if you get clocked a good one.

In medieval times, as far as I know, field (not tournament) helms were lighter gauge steel and some were better engineered than the one I use and the swords in general weighed less than the rattan sticks that I am familiar with. The helms were padded with horsehair in a liner and you often also wore a skull cap with a tie string. I do not know how that compares in shock absorption but from examining helms in Europe it seems that they would protect less than my present helm. There are lots reports of guys getting stunned by head shots even with the helmets on and no penetration of the shot so concussions happened back then. They probably protected better than saber masks especially for sharp weapons but not as good as my 12 gauge tank of a helm. Even with my thick and heavy helm I have on occasion taken shots that I would not want to repeat given the choice. In some respects it may be like having the football helmet protection. The more protection the bigger the stick and the more careful you have to be when dancing the line between getting concussed and having enough incentive. I wonder about this.

The worst was the day Brooke Brown came home to find her husband with a shotgun in his mouth. But there had been plenty of bad days before that: after he returned from a deployment in Iraq, Lance Cpl. David Brown would start shaking in crowded places. Sitting down for a family meal had become nearly impossible: in restaurants he'd frantically search for the quickest exit route. He couldn't concentrate; he couldn't do his job. The Marine Corps placed him on leave prior to discharging him. Brooke quit her job to care for him and the children. The bills piled up.

It sounds like another troubling story of a war vet struggling with PTSD. But Brown's case is more complicated. In addition to the anxiety, he suffered a succession of mild seizures until a devastating grand mal episode sent him to the hospital covered in his own blood, vomit, and excrement. There were also vision problems and excruciating headaches that had plagued him since he'd been knocked to the ground by a series of mortar blasts in Fallujah four years earlier.

Brown, now 23, didn't have any visible injuries, but clearly the man who left for Iraq was not the same man who returned. "Our middle son clings to David; he knows something is wrong," Brooke, 22, explained late this summer. "Our 4-year-old doesn't know what caused it, but he knows Daddy's sick and he needs help."

But what kind of help does Corporal Brown need? His case perplexed civilian doctors and the Department of Veterans Affairs. The headaches and seizures suggest that he is suffering from the aftereffects of an undiagnosed concussion—or, in the current jargon, mild traumatic brain injury (TBI). But some of his symptoms seem consistent with a psychological condition, posttraumatic stress disorder (PTSD). Or could it be both—and if so, are they reinforcing one another in some kind of vicious cycle? The person who knows David better than anyone, his wife, thinks it was hardly a coincidence that one of his worst seizures came on the day last year that his best friend was deployed with the Second Battalion, Eighth Marines, as part of President Obama's surge into Afghanistan. David Brown's symptoms have placed him at the vanguard of military medicine, where doctors, officials, and politicians are puzzling out the connection between head injuries and PTSD, and the role each plays in both physical and psychological post-combat illness.

Invisible Wounds

The military reports that 144,453 service members have suffered battlefield concussions in the last decade; a study out of Fort Carson argues that that number misses at least 40 percent of cases. By definition, a concussion is a shaking of the brain that results from a blow to the head. Typical symptoms include headache, memory loss, and general confusion. For decades, head injuries were a challenge mainly for civilian doctors, who studied the results of auto accidents and football injuries. The best treatment, it was generally thought, was rest and time. And in the great majority of these civilian cases, the brain heals by itself in as little as a week. Concussions sustained on the battlefield are another matter, and a vexing one. According to the Department of Veterans Affairs, symptoms such as vision, memory, and speech problems, dizziness, depression, and anxiety last far longer in men and women returning from combat. Why? Doctors suspect that the high-stress combat environment stifles the kind of recovery that would normally occur. More often than not, those unlucky enough to suffer a concussion in Afghanistan, or especially in Iraq, do so in stifling heat, "which can make the effects of a concussion worse," says David Hovda, director of the UCLA Brain Injury Research Center. Then there's the question of reinjury before full recovery. If an injured fighter reports symptoms that match the concussion watch list, he or she is pulled from action for 24 hours. (There's currently no test for a concussion besides self-diagnosis, though the military is actively pursuing biomarker tests that could be done on site.) But in a macho military culture, admitting unseen symptoms that can take you out of the action doesn't happen as often as it should. "If you ain't bleeding, you ain't hurt," says Brooke of the military culture around head injuries.

Blood or not, evidence is mounting that battlefield concussions from these two long-running wars could result in decades of serious and expensive health-care issues for a significant number of veterans. After all, TBI is a relatively new problem of modern warfare. Thanks to technological advances, warriors are surviving what once would have been fatal blasts--but the long-term consequences of the impact are still unknown. Two years ago, the RAND Corporation published a comprehensive study, "The Invisible Wounds of War," which highlighted brain injuries as a massive, and little-understood, mental-health issue for returning combat veterans. This summer the nonprofit journalism site ProPublica chronicled challenges in diagnosis of head trauma and breakdowns in care within the military medical system. Around the same time, the Senate Armed Services Committee called the brass from each of the military branches and the Department of Veterans Affairs to testify on the topic, and at the hearing senators expressed concern that head trauma may be a factor in service-member suicide. The military's concerns have arisen during something of a boom in concussion research in civilian institutions, and new research in sustained head trauma in athletes shows that repeated concussions can lead to a condition called chronic traumatic encephalopathy. This disorder, which can present 10 to 15 years after the initial trauma, is linked to depression and suicidal thoughts, as well as Parkinson's, dementia, and even a devastating neurological condition resembling Lou Gehrig's disease. Another study found that those who abused drugs and alcohol after a TBI had drastically increased rates of suicide attempts. Suicide is a serious threat to the military: an August 2010 report by the Department of Defense showed that the military suicide rate comes to one death every 36 hours. In the past, suicide has been associated with PTSD—an issue armed forces across the world have been struggling with for years. "Nostalgia" afflicted Napoleon's troops fighting his endless campaigns far from home. "Traumatic neurosis" and "shell shock" overcame British troops in the trenches of World War I. Col. John Bradley, head of psychiatry at Walter Reed Army Medical Center, describes today's PTSD as the inability to dial back on the instincts necessary for survival in combat even long after one is out of danger. "If you go back to your family and you still feel like you're in mortal danger, that creates a problem," says Bradley. A common estimate inside the military is that 20 percent of veterans in combat experience symptoms of posttraumatic stress. Some 2.1 million service members have been deployed to Iraq and Afghanistan—implying more than 400,000 potential cases. Connecting the DotsBut in Iraq and Afghanistan, the symptoms of PTSD are often complicated by TBI—a condition seen as a consequence of the fact that, thanks to better battlefield technology and medical care, more soldiers are surviving blasts that proved deadly in previous wars. Figuring out what's caused by PTSD and what's the result of a head injury isn't easy, especially since the symptoms of TBI overlap with those of PTSD. "You may have been injured, may have lost a buddy during an attack," says Bradley. "Traumatic brain injury has both a physical and psychological component, and so does PTSD." After a concussion, one is almost certain to have headaches, but headaches are also common among people with a mental-health disorder. Concussions cause trouble sleeping—and so can PTSD. Difficulty concentrating is common to both. "It's very difficult to determine if it's a psychological problem or the results of an organic brain injury," says Terry Schell, a behavioral scientist at RAND.

Scientists are just starting to understand if and how the two are connected. It's been shown in animal models that a head trauma can make one more susceptible to PTSD. "Minor traumatic brain injury does not necessarily cause PTSD, but it puts the brain in a biochemical and metabolic state that enhances the chances of acquiring posttraumatic stress disorder," says UCLA's Hovda, who is part of a civilian task force of doctors and scientists commissioned by the military to assess how PTSD and TBI affect troops. They'll meet in December to discuss whether troops suffering from both should receive special medical treatment. Hovda also played a key role in the development of the National Intrepid Center of Excellence, a military medical facility in Bethesda, Md., devoted to the care of returning vets who suffer from PTSD and/or head trauma. "When they get to Bethesda, or get home, a lot of times individuals will be suffering from symptoms related to these multiple concussions," he says. "They don't understand that it's related to a brain injury, and they become very depressed and confused."

Murray Stein, a neurologist at the University of California, San Diego, is leading a consortium of doctors and specialists through several clinical trials investigating the long-term effects of concussions mixed with high-stress situations. Stein suspects there's more to the long-term effects of battlefield brain injuries than we now understand. "Right now it's extremely controversial," he says. "It's simply too simplistic to suggest [TBI] and emotional symptoms can't be linked."

There's not a lot research as of yet. Early on in the Iraq War, Col. Charles Hoge, then the director of mental-health research at Walter Reed Army Medical Center, surveyed some 2,700 soldiers about battlefield concussions and PTSD, as well as the extent of their injuries and the state of their current mental and physical health (relying on self-reported measures like days of work missed). In 2008, The New England Journal of Medicine published Hoge's findings: battlefield concussions existed, perhaps in significant numbers, but "cognitive problems, rage, sleep disturbance, fatigue, headaches, and other symptoms" that had become commonplace among service members back home resulted almost entirely from PTSD. Hoge argued that attributing postcombat symptoms to the effect of concussions, which "usually resolve rapidly," could lead to a large number of military personnel receiving treatment for the wrong problem—treatment that could actually make things worse for the patient and put undue strain on the health-care system.In an interview with NEWSWEEK, Hoge agreed that there was a connection between the two conditions. "PTSD and battlefield concussions are interrelated, and they have to be treated as such," he said. But he's also standing by his findings that one should not be confused for the other. In his new book, Once a Warrior, Always a Warrior, published earlier this year as a mental-health handbook for veterans and their families, Hoge reiterates that "concussions/TBIs have also become entangled and confused with PTSD." Battlefield concussions, he writes, are best diagnosed at the time of injury, and the more time that elapses, the more difficult it becomes to link symptoms to the incident.

That much is true: with shoddy records of brain injuries from the early parts of the wars in Iraq and Afghanistan, many veterans who could be afflicted by the long-term effects of battlefield concussions will have little—if any—documentation to rely on in their claims for disability benefits. And as evidenced by Lance Cpl. David Brown, in some cases those men and women could require a significant amount of ongoing care.

The Path AheadThere's another, unsettling reality, of course: that PTSD and TBI are far from the only culprits for Brown's mystery symptoms. "Headaches are almost useless as a diagnostic," says Barry Willer, professor of psychology at the University of Buffalo and an expert on concussions. He notes that headaches present for a large number of illnesses. And depression, anxiety, and trouble sleeping? Those are often the result of living with an unexplainable illness. In reality, the troops are coming home with myriad medical issues, some new, like TBI; some, like PTSD, as old as war itself; and some a hybrid of the two. The question is whether we have the tools and treatments to figure out which is which.

Brown finally found some respite thanks to Tim Maxwell, a fellow Marine, who was pierced in the skull with shrapnel in Iraq and later lost his leg to mortar fire. Maxwell has established a quiet network of wounded warriors and maintains a Web site on the topic, SemperMax. Earlier this year, he got wind of Brown's struggle and helped get him back into the Marines and into the TBI ward at the National Naval Medical Center in Bethesda. Today, Brown's back at Camp Lejeune, readmitted to the Marines and working to get medically retired. "I spend most of my time over at the wounded-warrior tent doing rehab," he says. He's taking Topamax, a drug usually prescribed to epileptics to stave off seizures, and it seems to be effective, despite the side effects. "He's lost his speech for 30 minutes a couple of times," Brooke says, but he hasn't had any more grand mal seizures. His wife is fighting for him at every turn. "I'm going to stand by my man," she said in August, and then stiffened her spine. "He stood for me over in Iraq. The least I can do is stand by him now."

It's a nasty problem that's developing. Especially as explosives get better and research continues. Monitoring equipment improvements are starting to show that certain wavelengths

of blasts can penetrate the walls of concrete bunkers. Even in cases where the person is completely shielded from the blast, a cumulative effect can still cause injury.

I agree that TBI and PTSD can probably reinforce itself and cause a feedback loop. And that can be a nasty problem. Like doctors trying to figure out which part of a patient's symptom is the flu and which part is the staph.

A lot can be done with self-awareness, diet and lifestyle changes. I was military but my own stress-induced issues come from trauma inflicted in childhood. The issues were left undiagnosed and everyone just assumed I was a wild child. As I aged, I used to self medicate in the classic way: Drinking, fighting and talking to strangers in bars at 3am.

As an adult, I can say they were the classic PTSD indicators. To this day, I still occasionally get anxiety attacks when things are too quiet and going too well. I've learned to watch myself and recognize the symptoms. I've learned to apologize early and often. And to warn people when I'm having an off day or a spell.

I've found that, while not magic, a healthy diet, exercise, regular sleep at a regular schedule and a bunch of little changes in the house mellow out a lot of life's problems. A lot of tiny things can have major effects on a troubled brain. Flicking on a bright white bathroom light while staggering to relieve oneself in the middle of the night can cause chemical instability. Altering the bedroom so their are less vague shadows for the mind to play with. Adding some sound-dampening to the bedroom to reduce the chances of stray noises triggering the primal reflexes. A lot of simple things put together quickly adds up.

Having said that, I am always amazed at the coping mechanisms other far more severely affected individuals come up with. And I have deep sympathy and respect for people suffering under both TBI and PTSD. I've had both but never at the same time and can only wince.

The NFL is lending its public relations muscle to a proposal that would require California student athletes who leave a game after a head injury to get written medical clearance before returning to the field or court.

Retired players, including Raiders legends Jim Otto and Fred Biletnikoff and San Francisco 49ers Pro Bowl players Keena Turner and Eric Davis, recounted their own experiences Tuesday to support the measure in Sacramento.

Davis told how a blow to the head in a game against the Detroit Lions rendered him temporarily blind in his left eye. Reasoning that he played the left side of the field, and the bad eye was facing the sideline, Davis said he stayed in the game, unaware of the risk he was taking.

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Since then, research has shown that repeated head trauma can lead to brain bleeding, memory loss, depression and even death. Middle school and high school athletes, whose brains are still developing, are even more vulnerable than college athletes and professionals, according to the Centers for Disease Control.

The decision to leave a game should be "out of the player's hands, and out of the coach's hands," Davis said, because they can be too caught up in the competition to make good decisions.

The NFL, which drastically amended its own approach to the treatment of brain injuries following headlines about the tragic health problems of aging players, is backing legislation in 44 states this year that would require young players who suffer head injuries to stay off the field for at least the rest of the day and to get a medical professional's signature before they play again.

Parents would have to sign a "concussion awareness fact sheet" before their kids could play in a sports program in any league covered by the California bill. The prohibition would apply not only to official school teams but also to nonprofits and other organizations using public school facilities for youth sports.

Like legislation the NFL is backing around the country, California's is modeled on a Washington State law enacted after a middle school football player returned to the field following a head injury and suffered subsequent damage that left him connected to a ventilator, fighting for his life.

Assemblywoman Mary Hayashi (D-Castro Valley), sponsor of California's proposal, AB 25, backed unsuccessful legislation in the past that would have required high school coaches to be trained to spot symptoms of potentially dangerous head and neck injuries. Hayashi said she thinks the current bill stands a better chance of success because it would not place a financial burden on schools.

"We're assuming that the students are covered under their parents' healthcare plan," Hayashi said, and the required medical discharge would be no more burdensome than if "they had a cold, or the flu."

State Sen. Tony Strickland (R-Moorpark), the bill's co-sponsor, said he expected coaches to welcome the measure because it would relieve them of the burden of deciding whether a player could safely get back in the game following a potentially dangerous blow to the head.

More than 3 million sports and recreation-related concussions are suffered each year in the United States, according to the Centers for Disease Control. Football is the leading cause among high school boys; soccer is the main reason for high school girls.

Nearly half of those injured return to play too early, according to a 2010 report by the Center for Injury Research and Policy, based at the Nationwide Children's Hospital in Columbus, Ohio. Sixteen percent of high school football players who lost consciousness following a blow to the head returned to play the same day, the report says.

Staying in the game following head injuries was routine in the era when Otto, a Hall of Fame center, was snapping balls and taking a pounding for the Raiders in the 1960s and 1970s. Otto has endured nearly 70 surgeries on his knees, shoulders and hips to repair damage done during his years in the NFL's trenches.

Standing at the podium Tuesday, Otto motioned to his former teammate. "I remember looking over at Biletnikoff in the huddle, looking all cross-eyed, and saying, 'Snap out of it.' He'd say, 'I am snapped out of it.' "

Now that he understands the dangers of repeated head injuries, mostly from watching friends struggle with the long-term effects, Otto said, "It's imperative that this thing has to pass and that our children have to be protected."

Bobby Hosea, a 55-year-old former defensive back and longtime bit actor, has a singular passion: teaching young football players how to protect their heads while tackling. He has watched too many end up in wheelchairs, even coffins. He sees N.F.L. defenders recklessly diving helmet-first and claiming it is too late to change. He hears youth coaches exhorting tacklers to “lay a hat on him,” a maneuver so neck-crushingly dangerous it could well be called Rushing Roulette.

So Hosea runs camps that focus on one skill — tackling with your head up instead of down, and away from contact — and gives individual instruction to players in and around Los Angeles. As football careens through its dark cloud of head injuries, Hosea sees himself as saving more than the players’ ability to walk and think. He sees it as saving the sport, one youngster at a time.

USA Football, the governing body of Pop Warner and other leagues for players ages 6 to 14, recently hired Hosea as its tackling consultant and placed videos of his technique on its Web site.

“When a kid gets paralyzed or dies, it’s not an accident — the injuries happen because people never teach kids how to tackle the right way,” Hosea told about 20 rapt campers before a session this month. “Everyone’s talking about head injury awareness, awareness, awareness. What are you going to do about it? It drives me absolutely crazy. It’s time for this to stop!”

To lighten things up, Hosea could have amused the youngsters by reading the official definition of tackling, codified at Rule 3, Section 34 of the N.F.L. Rulebook: “The use of hands or arms by a defensive player in his attempt to hold a runner or throw him to the ground.” This quaint approach has evolved into the more gratifying and theatrical act of launching headfirst into a ball carrier’s gut, chest or helmet.

A result has been a steady rise in concussions — estimated at more than 500,000 each season among the 4.4 million children who play tackle football — as well as more rare but catastrophic injuries where vertebrae are crushed or fractured, leaving the player paralyzed.

“A lot of youth coaches have no idea how to teach tackling — they say to just put a helmet in the numbers or light the other guy up,” said Jeff Leets, whose seventh-grade son, Zack, is a defensive end and devoted Hosea pupil from nearby Torrance. “They have the caveman element and don’t want to be told their way is wrong or that their way is unsafe. Or they simply don’t know. It’s sad — you’ve got babies in your hands, man.”

On this Saturday, those babies ranged from a 9-year-old who weighed 70 pounds to a beefy high school senior eyeing junior-college ball. The players did not know Hosea from his playing days at U.C.L.A., in the Canadian Football League or in the United States Football League, nor did they recognize him from recent parts on “24” or “Bones.” To them, he is the tackling guy — equal parts coach, pal and drill sergeant.

Hosea takes a tackler’s most instinctual act — to dive toward a runner, head down and arms extended — and rebuilds it from the turf up. He keeps knees bent, backside out and chest up, bending the spine and forcing the chin and eyes up. Arms remain at the side until just before impact, when the hips and shoulders thrust up into the opponent, only then swinging forward to wrap up the runner and wrestle him down.

Hosea ran drills as unconventional as his method. The players lined up on their knees 10 at a time and flopped forward onto pads with their arms clasped behind their backs, looking like flying fish. In midair, they must call out the number of fingers a coach raises — to prove that their chins are up and eyes are alert. Elsewhere, they must run full speed under horizontal bars only 52 and 60 inches off the ground — Hosea’s so-called Dip-’n’-Rip sticks — before hitting tackling dummies to ensure that they stay low enough with proper form.

Any dropping of the head resulted not just in dozens of push-ups, but also in spirited hooting from fellow students.

“It gives me more confidence on the field — I feel like I’m not going to hurt myself,” said Michael Wilson, an eighth grader from Long Beach. “Before, I didn’t know what I was doing. When I was first taught, all the coach said was to put my head on the ball and knock it out.”

============

Hosea is barely known outside Southern California, where he still collides with traditionalist resistance; several parents at the recent camp said their local coaches disapproved of an outsider teaching their children how to tackle. One mother said she pleaded with local school district officials to use Hosea for their peewee programs but got no response.

Players at Bobby Hosea’s camps are taught to tackle with knees bent, backside out and chests up, bending the spine and forcing the chin and eyes up. “Bobby’s definitely the real deal — he’s a genius when it comes to this tackling stuff,” said Goldson, noting that teammates occasionally ask him to share the finer points of his tackling style. “If it wasn’t for him, I don’t know how many concussions I’d have.” Hosea’s current prodigy is Eric Capacchione, a senior at Torrance South High. Five years ago, Eric said to his father, “Dad, is it normal to see white lights when I tackle?” Bill Capacchione, who played college football and now cannot twist his neck more than a few degrees, knew that those white lights were not good. They were probably concussions.

Bill Capacchione — proudly noting that his surname in Italian means hard head — came upon Hosea’s tackling camps and became a quick convert. Eric has gone to about 100 three-hour sessions over five years, at the standard $40 a session, and this season was Torrance South’s most valuable player, leading the team to the district championship game. His 193 tackles were the second most in the state, according to MaxPreps.com.

“I don’t see the white lights anymore — mainly because I don’t hit my head in there,” said Eric, who will probably receive an N.C.A.A. Division I scholarship. “I don’t have to play afraid.”

This month’s campers certainly let loose. They shuffled and cut, imitated pterodactyls and pummeled foam dummies with a manic verve. At the end, Hosea gathered the group, seated them under a canopy and delivered his strident crescendo.

“Who breaks your neck and damages your brain?” Hosea said, yelling.

“Me,” the youngsters groaned. Dissatisfied, Hosea barked the question to each youngster individually and demanded the same answer.

“Me!”

“Are you ever going to put your head down on a tackle?”

“No, sir.” Not loud enough. “No, sir!”

When the grilling ended, Hosea exhaled. His final words came through a smile warm and hopeful: “You’re the new generation, guys. You’re empowered. You, my friends, are going to change the football world.”

The youngsters rose wearily, gathered their gear and trudged back to the parking lot under what had become a searing California sun. Their heads were up. The fog had lifted.

Interesting question presented here. To this article I would also raise the contrast suggested by Rugby's approach and football's approach:

====================By ALAN SCHWARZPublished: February 16, 2011

Camille Richardson has heard all the arguments, read all the comments, and sees the logic. But as a freshman midfielder for the Columbia women’s lacrosse team who is fully aware of the dangers of head trauma, Richardson makes one thing clear: She has no interest in wearing a helmet, as the men must.

“Wearing a helmet,” Richardson said, “would just bring us closer to football and hockey.” Although some safety advocates call for head protection in women’s lacrosse, almost everyone involved in the sport has said that its current ban on helmets for everyone but goaltenders is actually the safest approach. Hockey safety experts question if helmets foster more physical play. Football looks back and wonders whether big face masks encouraged a recklessness that can lead to long-term brain damage.

Now at its own crossroad, women’s lacrosse — with 250,000 playing nationwide — wants to take the road less battered. And so begins the second stage of sports’ continuing parry with head injuries — in which the best protection, many experts insist, is no protection at all.

“It’s hard to absolutely prove, but what we’ve seen is that behavior can change when athletes feel more protected, especially when it comes to the head and helmets,” said Dr. Margot Putukian, Princeton’s director of athletic medicine services and chairwoman of the U.S. Lacrosse safety committee. “They tend to put their bodies and heads in danger that they wouldn’t without the protection. And they aren’t as protected as they might think.”

Although boys’ lacrosse rules mandate helmets and face masks at all age levels, girls’ lacrosse, whose season at many schools begins this month, is drastically different. Amy Bokker, Stanford’s women’s coach, only half-jokingly says that it shouldn’t be called lacrosse at all.

Girls at all levels cannot body check; collisions are minimized.

Contact with the head is so off limits that accidental intrusion with stick or body within seven inches of the head — an area known as the halo — is a major foul. Even shooting with a defender in line with the goal is illegal.

Even so, girls’ lacrosse does see its share of concussions, mostly on accidental stick-to-head contact, collisions and falls. According to research by Nationwide Children’s Hospital in Columbus, Ohio, not only does the sport have the third-highest rate of concussion among female scholastic sports (behind soccer and basketball), but its in-game rate is only about 15 percent less than the rougher male version.

Research suggests that even though men’s lacrosse helmets are required only to eliminate skull fracture and intracranial bleeding — like football helmets — the headgear is probably decreasing the concussion rate to some extent. Yet as recently as December, the New York State Public High School Athletic Association voted by 9 to 2 to continue banning hard helmets in the women’s game, a stance echoed by U.S. Lacrosse.

Not everyone agrees with that decision.

“Any time we can prevent a concussion, we should try to do it,” said Dr. Brian Rieger, director of the Central New York Sports Concussion Center, who has shared his feelings with U.S. Lacrosse. “Even though it’s usually a short-lived event, there are certain situations, I’ve seen it, where even a kid with one concussion can be out of school for weeks or months, and struggle. When you see a child or parent go through it, it makes me feel we should do anything to prevent it.”

At the annual meeting last month of the National Organizing Committee on Standards for Athletic Equipment, or Nocsae, which sets performance standards for almost all organized sports’ safety gear, one of the most heated exchanges concerned U.S. Lacrosse’s continued ban on hard helmets and face guards. Dr. Jack Ryan, representing the American Orthopaedic Society for Sports Medicine, complained: “Somebody’s got to stand up and say, What are you doing? This to me is like, come on, you’re not serious. This is 2011.”

Then again, other sports have spent the last several years realizing that safety equipment can bring dangers of its own. Checking in professional hockey became considerably more vicious with the adoption of helmets in the 1970s and ’80s, and football players felt so protected by their helmets and face masks that head-to-head collisions became commonplace at every age level. Scaling back protection now in order to dissuade violent play would be too dangerous, experts say, both physically and legally.

Even though women’s lacrosse rules against contact would be unchanged or even strengthened with the adoption of helmets, the ethos would almost certainly change, more than a dozen coaches, players and officials said in interviews. One of Camille Richardson’s teammates at Columbia, the senior attacker Olivia Mann, said that after the move to make eyewear mandatory for the 2005 season, “It’s subconscious, but you see harder checking, and rougher play.”

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Richardson and Mann gladly demonstrated what they see helmets doing to their sport. As Mann played defense and Richardson cradled the ball with her head up, the women used their feet to grab position and cut.

The term, they explained, was to “wrong-foot” your opponent. They were then asked to pretend they were wearing helmets. Without knowing it, solely on instinct, Mann violated the halo rule by swinging her stick close to Richardson’s head. This was partly because Richardson, feeling protected, slightly dipped her head and leaned in toward, rather than away, from contact.

“I would be more likely to take risky checks, which would change the nature of defense completely,” Mann said. “Now, trying not to foul her, it’s very much about where I get my hands and body. If she’s wearing a helmet, I don’t have to worry about physically injuring her. I’m more likely to sacrifice my body positioning to get at her stick.”

Another teammate, Kelly Buechel, said, “You want someone to beat you because they’re more skilled than you, not because they’re more brutal than you.”

Mouth guards and eye guards are required in women’s lacrosse. And the rules have for decades allowed soft headgear — usually a headband or a crown of soft padding, borrowed from kickboxing or elsewhere. But these go essentially unused because players consider them either unnecessary or ugly. (Web sites for three women’s lacrosse equipment outlets don’t list any sort of head protection for sale.) The rare women’s player who does wear the soft headgear, experts said, usually has a prior head injury and is feeling more protected than she actually is.

In November, U.S. Lacrosse did accede and approach Nocsae about developing a standard for some form of head protection for women — almost certainly soft — that might protect against some stick-to-head concussions. Nocsae officials at the annual meeting recommended at least hard face masks, if not helmets, and somewhat grudgingly accepted the assignment.

The U.S. Lacrosse president, Steve Stenersen, said that during this age of concussion awareness in youth sports, he opposed any headgear that would, he said, “upset the balance between safety and game integrity, or bring some unintended consequence.”

“Everybody looks at equipment intervention as the end-all, be-all — but it’s not, and the football discussion bears that out,” Stenersen said. He added that U.S. Lacrosse would rather emphasize education and rules enforcement and keep the game unchanged.

“People are less focused on those because they’re less tangible, and the picture of a helmet on a kid makes them feel better,” he said. “But it’s much more complicated than that.”

When the former football player Andre Waters shot himself in the head in late 2006, the few recoverable pieces of brain tissue, which later showed the same degenerative disease previously associated only with boxers, made the health risks of football a national conversation.

Football’s ramifications so concerned the former Chicago Bear Dave Duerson that, after deciding to kill himself last Thursday, he shot himself in the chest, apparently so that his brain could remain intact for similar examination. This intent, strongly implied by text messages Duerson sent to family members soon before his death, has injected a new degree of fear in the minds of many football players and their families, according to interviews with them Sunday. To this point, the roughly 20 N.F.L. veterans found to have chronic traumatic encephalopathy — several of whom committed suicide — died unaware of the disease clawing at their brains, how the protein deposits and damaged neurons contributed to their condition.

Duerson, 50, was the first player to die after implying that brain trauma experienced on the football field would be partly responsible for his death.

Retired and current players roundly noted on Sunday that they could not know what Duerson’s mind-set was and what other events in his life had contributed to his actions. Yet the gunshot from Duerson’s home in Sunny Isles Beach, Fla., and the final wishes for his brain shook players around the nation.

“Oh my God — he might have been aware of what was happening to himself?” the former Giants running back Tiki Barber said when informed of the circumstances. After taking a moment to collect himself, Barber continued: “It feels like this was calculated and thought-out to some extent. It was almost with a purpose.”

Randy Cross, a former San Francisco 49ers lineman, said, “It ought to terrify anyone that’s played the game.”

Players who began their careers knowing the likely costs to their knees and shoulders are only now learning about the cognitive risks, too. After years of denying or discrediting evidence of football’s impact on the brain — from C.T.E. in deceased players to an increasing number of retirees found to have dementia or other memory-related disease — the N.F.L. has spent the last year addressing the issue, mostly through changes in concussion management and playing rules.

The N.F.L. has also donated $1 million to Boston University’s Center for the Study of Traumatic Encephalopathy, the research group that will soon examine Duerson’s brain.

Duerson sent text messages to his family before he shot himself specifically requesting that his brain be examined for damage, two people aware of the messages said. Another person close to Duerson, who spoke on the condition of anonymity, said that Duerson had commented to him in recent months that he might have C.T.E., an incurable disease linked to depression, impaired impulse control and cognitive decline. Members of Duerson’s family declined an interview request through a family friend.

Duerson was a four-time Pro Bowl safety, primarily for the Bears. He won Super Bowls with the Bears and the Giants and retired in 1993.

For the past several years, Duerson served on the six-person panel that considers retired players’ claims through the league’s disability plan and the 88 Plan, a fund founded in 2007 to help defray families’ costs of caring for players with dementia. So Duerson would have been familiar with the stories of hundreds of retirees with mental issues ranging from impaired short-term memory to outright dementia.

“You know he’s been sitting in the disability meetings and the applications, so I’m sure he’s seen a lot of disability applications that have to do with brain injury,” said Ben Lynch, a center for the 49ers from 1999 to 2002. “Having seen all those things come across in front of him, and for him to make the request about his brain, it’s something that must have been really on his mind. It’s unbelievable to me that this happened. The fact that he shot himself in chest, and not the head, it’s really eerie.”

Matt Birk, a center for the Baltimore Ravens, is one of 6 current N.F.L. players and 103 in all who have pledged to donate their brain to the Boston University center for analysis after their death. He said that Duerson’s requesting the same before shooting himself in a way punctuated the first era of the investigation.

“It’s almost now to the point that — not that it’s not tragic — but now it’s almost becoming common, some former players with some form of brain problems,” Birk said. “Is it something that I think about? Yeah, absolutely. There’s a little bit of, ‘Well, it’s not going to happen to me.’ ”

Duerson was successful in private food-related business after he retired, but he had encountered financial and family problems in recent years. In 2005, he resigned from the Notre Dame board of trustees after he was charged with pushing his wife, Alicia. The next year, he sold most of his company’s assets at auction. In 2007, the Duersons filed for divorce, and their home in Highland Park, Ill., went into foreclosure, according to The Chicago Sun-Times.

Duerson relocated to Florida and remained heavily involved with issues regarding former N.F.L. players. Last spring, he attended a gathering of veterans in Fort Lauderdale held by the Gay Culverhouse Players’ Outreach Program, founded by Culverhouse, the former Tampa Bay Buccaneers president, to help league retirees apply for medical and pension benefits. Mitchell Welch, the organization’s vice president, said that when discussion that day turned to the 88 Plan — the program for players with dementia — some veterans’ minds wandered, some appearing as if the topic of mental decline did not apply to them. Duerson walked to the front of the room and asked to say some words to the players, which Welch, in an interview Sunday, said he now would never forget.

Marine Lance Cpl. Tristan Bell was injured in a jarring explosion that tore apart his armored vehicle, slammed a heavy radio into the back of his head and left him tortured by dizziness, insomnia, headaches and nightmares.

He is recovering on a padded table at Camp Leatherneck, Afghanistan, beneath strings of soft, white Christmas lights, with the dulcet notes of "Tao of Healing" playing on an iPod and a forest of acupuncture needles sprouting from his head, ear, hands and feet.

In a bit of battlefield improvisation, the Navy is experimenting with acupuncture and soothing atmospherics to treat Marines suffering from mild cases of traumatic brain injury, commonly called concussions—the most prevalent wound of the Afghan war.

After hitting on the idea in late November, Cmdr. Keith Stuessi used acupuncture, along with the music and lights, to treat more than 20 patients suffering from mild brain injuries. All but two or three saw marked improvements, including easier sleep, reduced anxiety and fewer headaches, he says. Cmdr. Earl Frantz, who replaced Cmdr. Stuessi at Camp Leatherneck last month, has taken charge of the acupuncture project and treated 28 more concussion patients.

"I think a couple years down the road, this will be standard care," predicts Cmdr. Stuessi, a sports-medicine specialist turned acupuncture acolyte. "At some point you have to drink the Kool-Aid, and I have drunk the Kool-Aid."

While researchers are still investigating how exactly it works, studies have found that acupuncture can help relieve pain, stress and a range of other conditions. The newest Defense Department and Department of Veterans Affairs clinical guidelines recommend acupuncture as a supplementary therapy for post-traumatic stress disorder, pain, anxiety and sleeplessness.

The VA is recruiting candidates for a study of acupuncture's effectiveness in treating PTSD and traumatic brain injury. Based on other studies of its benefits, "there is good reason to believe that acupuncture will induce recovery across a number of trauma spectrum dysfunctions in patients with TBI and PTSD, at low cost and with little risk," the VA wrote.

In 2008, the Navy put Cmdr. Stuessi, a 44-year-old from Wales, Wis., and a handful of other doctors through a 300-hour acupuncture course. When he came to Afghanistan in August to create a clinic to treat concussions and minor physical injuries, the commander brought his collapsible needling table. He expected to use it for the usual array of sprained ankles and sore backs.

Once at Camp Leatherneck, though, Cmdr. Stuessi stumbled across an article about using acupuncture to treat PTSD and realized many of the symptoms overlapped with those of mild traumatic brain injury: insomnia, headache, memory deficit, attention deficit, irritability and anxiety.

Lance Cpl. Bell, 22, from Billings, Mont., was patrolling a ridgeline in mid-January when the Marines in his vehicle spotted a half-buried bomb in the road ahead. They backed up onto a second booby-trap, leaving five of the seven crewmen, including Lance Cpl. Bell, unconscious. He took medicine, but the headaches and insomnia grew relentless as the days passed. "If I took a nap, I'd have nightmares and crazy dreams," he says. "I don't take naps."

He was waiting to see his regular doctor when Cmdr. Stuessi invited him to watch another Marine get acupuncture. The lance corporal hates needles, but he was getting desperate. The back of his head throbbed so hard it made his eyes hurt. "I thought, 'Something has to change here—I want to get back out there,' " he recalls.

The night after his first session, he slept eight hours, twice what he had managed before. Soon he was returning eagerly every three days, when the benefits began to fade. He made a recent visit after a bad night, in which he woke up disoriented, headed out for a smoke and hit his head on the bunk bed.

When Lance Cpl. Bell showed up at Cmdr. Stuessi's plywood office in a green Marine Corps sweatshirt and camouflage pants, the doctor turned off the overhead fluorescent light and switched on a string of Christmas lights his wife had shipped him. He shuffled his iPod from "Mack the Knife" to the flute notes of his healing music.

He slipped one needle into the top of the Marine's head, and more into his left ear and hands. As he worked, he spoke softly of "chi," which he described as the rush of numbness or warmth when the needle hits the spot, and "shen men," a point in the ear connected to anxiety and stress. "This is Liver Three," he said, sliding a needle into Lance Cpl. Bell's left foot and moving it until the Marine felt the desired effect.

A 2008 RAND Corp. study found that one in five troops who serve in Iraq or Afghanistan suffers traumatic brain injury, ranging from severe head wounds to more common concussions. Standard treatment for the latter can involve painkillers, antianxiety medication, sleeping pills, counseling and group therapy.

Acupuncture immediately appeared to speed recovery, Cmdr. Stuessi says. His first patient, unable to sleep more than four hours a night despite two weeks of standard treatment, put in 10 hours the night after his initial needling. Most other patients have seen similar results.

Lance Cpl. Dominic Collins, who shared a vehicle with Lance Cpl. Bell, was plagued by headaches after the bombing. One night in February, he dreamed he was being mortared. He rolled out of his bunk to take cover.

He declined the clinic's offer of acupuncture. "It's kind of not my thing," he says. "I have tattoos, but it's the idea of getting stuck" that puts him off.

One Marine tried jokingly to discourage Cpl. Francisco Sanchez, who hit two mines in one day, from using acupuncture by making him sit through an action movie in which the hero stabs the villain with a needle in the back of the neck. The villain's eyes bleed. Then he dies.

But word has spread around camp, and Marines with everything from job stress to snuff addiction now plead for acupuncture.

"All we can say is we've learned from the Chinese on this," Cmdr. Stuessi says. "They've been doing this for a couple thousand years."

A news story this week: http://www.startribune.com/sports/wild/121813554.html NHL star Derek Boogaard was found dead in his Minneapolis apartment Friday, five months after he sustained a season-ending concussion with the New York Rangers. There was a delay to announce cause of death; now they say suicide. The family has donated his brain at his request to research: http://www.usatoday.com/sports/hockey/nhl/2011-05-16-1035067980_x.htm "... spokeswoman for the Boston University School of Medicine confirmed Sunday that his brain will be examined for signs of a degenerative disease often found in athletes who sustain repeated hits to the head." BU Center for the Study of Traumatic Encephalopathy I think will be a good place to start for existing research.

A more simple answer to your question. Your sport and so many others I think need to figure out how to keep the intensity up but get the impact to the head down. The better we are able to measure damage, the more we are going to find. 'What's your head worth?'----(Update: The NHL death above is now called accidental overdose, oxycontin and alcohol.)

A more simple answer to your question. Your sport and so many others I think need to figure out how to keep the intensity up but get the impact to the head down. The better we are able to measure damage, the more we are going to find. 'What's your head worth?'

I have a glass jaw. Not everyone is cut out for fighting.

At each one of my classes, we kick one another in the legs, punch and kick one another in the gut, and knee one another in the legs and arms via the plum. The leg kicks are all shin snap kicks and muay thai kicks of various sorts, and at least once a week I get dropped from a single leg kick. As a result, I have a very clear idea of what kinds of hits I can take and give, and what the reaction will be from different kinds of people. I'm a pretty high defense oriented person because I HATE getting hit in the head and face, and I can usually go weeks in between head hits from MMA people, hard as amateurs may try.

Something I wondered for a long time though was how hard I could hit people with TKD snap kicks. I always just touched like I was point fighting because I always felt they were stronger than the shin kicks. About a year ago I decided to start hitting people harder with them, to see what would happen. I didn't mess around with this much because, as it turns out, you can barely touch most people with them without them falling over in pain.

Then I got to thinking how many times I got beat by a single hit to my head. Actually, not to long ago I got taken out of fighting for the night because of one snap hook kick to my elbow completely ruined my arm for a couple days.

I feel like, from watching fighting, there is this AMAZING upper one percent of people that can endure incredible pain. People that suffer broken facial bones, broken arms, broken feet, that keep on fighting like nothing is wrong unless a ref stops them. Most people in the UFC, or even in pro boxing aren't like that. The fight can go on and on because they are GOOD at fighting and protecting themselves, but the first clean shot that lands changes everything. To me, the question of how much can the human body take, I guess I think the answer is, "unless you were born a part of that amazing upper 1%, not very much at all."

I really have come to believe in the way I like to spar. We kick one another in the legs really hard, and strike the safer parts of the torso pretty hard, but we don't hit the face and head any harder than a solid slap. I feel like we are building up our pain tolerance, our skill under stress, and our real abilities without really risking all that much. I have a broken finger right now, but that's minor. I was able to keep going for a bit after it happened. It isn't like suffering a concussion.

I don't believe that there is much of anything to be gained from sparing with unrestrained strikes to the head. I don't believe my reflexes would be any better if was forced to deal with more people that didn't care about protecting me. No one likes a hard slap across the face: it hurts and it is embarrassing. It takes a lot of skill to deliver it with a kick instead of missing or hitting too hard. It gets just about the same response out of the target - but it doesn't risk much.

Derek Boogaard, a former National Hockey League player, had a degenerative brain disease linked to repeated head trauma when he died in May at age 28, according to researchers.

The disease, chronic traumatic encephalopathy, widely known as C.T.E., is a close relative of Alzheimer’s disease and has been diagnosed in the brains of more than 20 former football players. It can be diagnosed only posthumously.

The researchers at the Boston University Center for the Study of Traumatic Encephalopathy who examined Boogaard’s brain said the case was particularly sobering because Boogaard was a young, high-profile athlete, dead in midcareer, with a surprisingly advanced degree of brain damage.

“To see this amount? That’s a ‘wow’ moment,” said Ann McKee, a neuropathologist and a co-director of the center.

Boogaard was one of the sport’s most feared fighters, filling the role of enforcer for the Minnesota Wild and the New York Rangers. Over six seasons in the N.H.L., he accrued three goals and 589 minutes in penalties. On May 13, his brothers found him dead of an accidental overdose in his Minneapolis apartment.

The degenerative disease has been found in the brains of all four former N.H.L. players examined by the Boston University researchers. The others were Bob Probert,, who died at age 45; Reggie Fleming, 73; and Rick Martin, 59.

For N.F.L., Concussion Suits May Be Test for Sport ItselfBy KEN BELSONPublished: December 29, 2011 o

The long debate over the National Football League’s handling of concussions is reaching the courts in a flurry of lawsuits, raising the possibility that dozens of former players will go before juries to outline the league’s medical practices and describe long-term cognitive problems they say were caused by the sport. More than a dozen suits, filed since July on behalf of more than 120 retired players and their wives, say that the N.F.L. and in some cases helmet manufacturers deliberately concealed information about the neurological effects of repeated hits to the head. Several suits also say that even if the league did not know about the potential impact of brain trauma sustained on the field, it should have known. Taken together, the suits filed in courts across the country amount to a multifront legal challenge to the league and to the game itself. While the retired players, including stars like Jim McMahon and Jamal Lewis, face a time-consuming and difficult battle, the N.F.L. will have to spend heavily on lawyers to fend off the chance that juries might award the retired players millions of dollars in damages. The league must also grapple with unflattering publicity as former players claiming to be hobbled by injuries and, in some cases, suffering from financial problems sue their former employer, the steward of America’s most popular sport. The stakes will only get higher if any of the cases go to trial, where details may emerge about what the N.F.L. knew about concussions and when, how it handled that information, and whether it pushed manufacturers to make the safest helmets possible. “I don’t think the N.F.L. can consider these cases nuisances,” said Mark Conrad, who teaches sports law at Fordham University. “They will take them seriously because if it goes the wrong way, it could be a bombshell.” The N.F.L. is no stranger to the courts. In the past few years, it has tangled over merchandising, drug testing and antitrust exemptions. But those issues were largely alien to the average fan and barely slowed the league’s primary mission to put on games. The notion of retired players telling a jury the league is at least partly liable for their dementia and other cognitive disabilities is an entirely different matter, legal experts say, because the players’ testimonies are bound to get a sympathetic audience and cast a shadow over the league. “We believe that the long-term medical complications that have been associated with multiple concussions — such as memory loss, impulse anger-control problems, disorientation, dementia — were well documented, and that factually the N.F.L. knew or should have known of these potentially devastating neurological problems, and yet it didn’t take any active role in addressing the issue for players,” said Larry Coben, who represents seven retirees, including McMahon, the quarterback who helped lead the Chicago Bears to a Super Bowl victory in 1986. Brad Karp, an outside counsel for the league, said: “The N.F.L. has long made player safety a priority and continues to take steps to protect players and to advance the science and medical understanding of the management and treatment of concussions. The N.F.L. has never misled players with respect to the risks associated with playing football. Any suggestion to the contrary has no merit.” A trial is not imminent, however, and may never occur, legal experts said. The league will try to get the cases dismissed, they said, and the former players must hope a judge will allow the cases to proceed. In a sign of the high hurdles facing the retired players, the league has successfully convinced at least one federal judge that any claims by the players should be handled under the collective bargaining agreements that they signed during their N.F.L. careers. The retired players, naturally, disagree. They argue that as retirees, they are no longer party to those collective bargaining agreements and that only since they stopped playing did they unearth evidence that they were not adequately warned of the dangers of concussions. The debate over this issue may be settled in Philadelphia after the league and many of the plaintiffs ask the Judicial Panel on Multidistrict Litigation, a federal board, to combine all the cases and move them to federal court in the Eastern District of Pennsylvania. The N.F.L. prefers this approach because it allows its lawyers to focus on a single case that will produce a single resolution, and reduce the possibility of inconsistent rulings by different judges. Assuming the players can persuade a judge to let their case go forward, they will most likely argue that the N.F.L. rejected widely accepted science on head trauma for years, and that the league’s doctors produced research that later was found to be severely flawed. Page 2 of 2) Several suits note that in 2007, the league distributed a pamphlet to players that said, “Current research with professional athletes has not shown that having more than one or two concussions leads to permanent problems if each injury is treated properly.” The league left open the question of “if there are any long-term effects of concussion in N.F.L. athletes.” The cases also note that in October 2009, Roger Goodell, the commissioner of the N.F.L., was criticized by lawmakers for neglecting the league’s handling of active and retired players with brain injuries. A month later, the two directors of the N.F.L.’s committee studying concussions who were accused by the retired players of whitewashing the issue stepped down. Only last year, the retired players say, did the N.F.L. begin alerting current players to the long-term effects of concussions. One poster created by the league used words like “depression” and “early onset of dementia.” Another document warned players that repeated concussions “can change your life and your family’s life forever,” a nod to retired players’ wives who have spoken out on the issue. The league, though, is expected to point out that these publications are part of its continuing efforts to care for players, and that the league provides medical benefits for retired players. The league will also argue that the players knew that the sport was dangerous when they played and yet they did not stop. “The N.F.L. will try to convince the court that the game is inherently risky,” said Matthew J. Mitten, the director of the National Sports Law Institute at Marquette University. “There is this warrior mentality in the N.F.L. where you play through pain.” A far murkier obstacle for the players is proving that the concussions they sustained in the N.F.L. caused their current health problems. It will be difficult to prove that any impairment is not a result of head trauma sustained while playing in high school and college. “The proof problems will be enormous,” said Paul Haagen, the co-director of the Center for Sports Law and Policy at Duke University. “Everyone who has played in the N.F.L. has played in the lower levels and suffered some injuries that are consistent with these.” The retired players may also have difficulty proving the league deliberately hid information from them. Even if they do, legal experts said, the league will point to the rule changes it made to outlaw spearing and other dangerous practices involving helmets, and the millions of dollars it has spent over the years to study head trauma. “The problem is there isn’t necessarily a smoking gun,” said Robert Boland, who teaches sports law at New York University. “The N.F.L. will say we found out about it when you did, and we never saw this kind of damage before.”

[Admin: I'm not 100% sure if this is the right place to post this. It's certainly related to the topic but is also somewhat circumstantial. If it belongs elsewhere, please feel free to move it.]

The neurologist who screens boxers and MMA fighters for the state (California) happens to be a family friend and my parents' neighbor. I bumped into him the other day, and we got to talking about head trauma, etc. Basically the topic of this thread, so I won't belabor it. He confirmed that the more they learn about the long-term effects of repeated concussions (or perhaps as or more worrisome, multiple sub-concussive blows), the worse it looks.

He also mentioned that he's putting together a study of boxers and MMA fighters, which he is hoping the state will sponsor. That hasn't come through yet, but the testing might still be of interest to those who fight in the Gatherings. The general idea is to get periodic neurological screening to establish a baseline. He didn't go into detail about the test they use, but he said it involves a deck of cards -- since that's easy to understand and crosses language/cultural barriers. Apparently the results are quite stable over a long time frame in the absence of trauma. With a baseline in place, it becomes possible to notice whether things are getting worse. Or if an acute trauma occurs (say you take a hard shot and feel woozy), you can get tested again and have a quantitative sense of the effect. The idea is that you'd refrain from further contact until you (hopefully) tested 'normal' according to your established baseline again. This is all just from memory, so I may have gotten some details wrong, but hopefully you get the general idea.

As we talked about all this, I realized this is probably important. It's something I want to do for myself. I won't wax too personal in this post, but Guro Crafty recently made a post elsewhere discussing the issue of 'how much is enough'? That helped focus my thinking about the whole topic. I think everyone who fights at the Gatherings understands the benefits, and one thing I really appreciate is that we have a thread like this which helps us to understand what the costs may be. Participating with open eyes is, I think, an important part of getting the most out of what can be a highly transformative experience. It's part of what separates an event like the Gathering from random brawling . . .

In the three years I have fought so far, there has always been at least one person who takes a hard shot. The fact is, the possibility of hard head shots is an irreducible part of what makes a Dog Brothers' encounter what it is. It's the reality of that possibility which focuses the tactics and mindset required to participate. When I described the headgear (fencing masks) to the doctor, his (neutral) response was, "That doesn't really provide much actual protection of the head (as opposed to the face), does it?" And he has a point.

In any case, that was a longwinded introduction. What I wanted to say is that the testing takes place at his office, which I believe is in San Pedro, on Tuesday and Friday afternoons. The study hasn't been funded yet, so there's no subsidy for the cost, which is $85. However, if a group of fighters wanted to be tested, he said they could do it 'a little cheaper'. I don't know whether this is useful or interesting for anyone, but I thought I would throw it out there. I plan to have the testing done before I fight again, and I told the doctor (I'm not including his name for privacy reasons) I would put out feelers to see if anyone else wanted to. If nothing else, I think the reasoning I've laid out here is part of an important conversation fighters should be having (at least with themselves).

I have no personal stake in this. I just thought a more quantitative diagnostic might be valuable for others wrestling with the question of 'how much is enough'? I've gained so much through the opportunity the Gatherings present, and I want to see them continue with as few negative after-effects as possible -- so everyone involved can 'walk as a warrior for all of their days'. Since this happened to come up and seemed so relevant, I thought I would pass it on, in case anyone else wants to participate. If so, I guess PM me, and we can take it to email.

You don't want to only 'walk as a warrior for all of your days' unless you can think like one as well.

I'm reminded of a former boxer in his 50's who was physically quite impressive but was a victim of some sort of dementia to the degree where he was rendered non-verbal and mostly catatonic until the occasional bell rung in his head resulting in a nurse or another passerby getting a right hook.

Was this from boxing? Well, I can't say for sure, but if I had to guess.....

Woof C-Mongolian Dog - I am very curious as to which screening tool he is using or if the study is attempting to validate a new screening tool. One of the ideas of many of these tools is to establish a baseline that can be given by different administrators over time and still be valid (i.e. comparable results for the same individual assuming no baseline change). If so, this should be easily reproducible. Any chance you could find out which tool he is using? Two more common ones are the SCUT and the MACE (I don't remember what they stand for) and I know there are others. There's also a free app you can download onto your iPhone called imPact which is supposed to be really useful for trainers and similar people that has the screening guidelines and questions all loaded for you - perfect when your there on the sidelines and are not quite sure what to do next. I've never actually used it but its supposed to be very helpful and is free and is better than sitting there guessing what to do next. I'm going to finally get around to downloading it as soon as I'm done here, and will report back a little more after I've had a chance to look it over better.

It is ABSOLUTELY critical to protect your IQ. That's part of the reason I do RCSF instead of heavy muay thai or MMA sparring. Yes, we take the occasional headshot but those guys do it ALL THE TIME, and the sum total damage is much more over time than we get in the gatherings. My brief recent stint in a boxing class gave me cause for concern enough to where I was weighing whether I could justify staying in it, when my coach left town and saved me the decision. I consider that far more dangerous than what we do, certainly on average over time. The big thing with FMA is simply practicing and sparring with protecting your head first and foremost goal and fighting like you want to live. That's the best protection.

For anyone who might be taking care of head injured athletes (i.e., anyone who might be leading a class) this seems like it might be a good investment. $44 is a little pricey but peace of mind is worth it. $44 on iTunes store. With you all the time and can store baseline scores for multiple people over time for comparison.

King-Devick Concussion Screening TestBy King-Devick Test, LLC

There may be more or cheaper ones out there, but this seems pretty good. I would recommend practicing on people for fun or getting baselines BEFORE someone is actually injured to make yourself comfortable with it under good conditions without adrenaline and pressure.